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THE 



DYSPEPTICS MONITOR: 



NATURE, CAUSES, AND CURE 

OF THE DISEASES CALLED 

DYSPEPSIA, INDIGESTION, LIVER COMPLAINT. 
HYPOCHONDRIASIS, MELANCHOLY, ETC. 



BY S. W. AVERY, M. V, 



Optimum autemest, ejus modi hominibus praeservationem, a priori injungere, i* 
iegimine et diseta, atque illos ab abusu talium dehortari.— Stahl. 



NEW-YORK: E, BLISS, 111 BROADWAY, 




1830, 



V 



^ 



Southern District of Nezo-Yerk, ss. 

BE IT REMEMBERED, That on the thirteenth day of August, A. D. 1830 
in the fifty-fifth year of the Independence of the United States of America. 
Elam Bliss, of the said District, hath deposited in this office the title of a 
book, the right whereof he claims as proprietor, in the words following, to wit: 
11 The Dyspeptic's Monitor , or the nature, causes, and cure of the diseases 
called dyspepsia, indigestion, liver complaint, hypochondriasis, melancholy, 
etc. By S. W. Avery, M D. Optimum autem est, ejus modi hominibus prae- 
servationem, & priori injungere, in regimine et diaeta, atque illos ab abusu taliura 
dehortari.— Statd." 

In conformity to the act of Congress of the United States, entitled " an 
act for the encouragement of learning, by securing the copies of maps, charts, 
and books, to the authors and proprietors of such copies, during the time 
therein mentioned." And also to an act, entitled "An act, supplementary 
to an act, entitled an act for the encouragement of learning, by securing the 
copies of maps, charts, and books, to the authors and proprietors of such 
copies, during the times therein mentioned, and extending the benefits thereof 
to the arts of designing, engraving, and etching historical and other p&nta." 

FREDERICK J. BETTS, 
Clerk of the Southern District of New- York 



J. SEYMOUR, PRINTER, JOHN-STBEET. 



PREFACE. 



If an apology were necessary for coming before 
the public with a work of this sort, the mere fact 
that we are indebted to Europeans for all the best 
treatises on indigestion within the reach of the ge- 
neral reader, might be considered sufficient, while 
our climate, peculiarities of diet, habits, and modes 
of living, unquestionably exercise a powerful influ- 
ence upon our constitutions, and give a character 
to many of our diseases, appreciable only by a resi- 
dent in the country. 

The great prevalence of indigestion among us 
renders it a subject of more or less interest to al- 
most every individual, as there are very few in easy 
circumstances who have not occasionally suffered 
from some of its forms, or who have not connex- 



IV PREFACE. 

ions or friends whose lives are embittered by 
How many drag out a miserable existence in con- 
sequence of perpetual headachs, heartburns, acidi- 
ties, pains in the side, and a thousand nervous ail- 
ments depending upon bad digestion, which are 
made doubly oppressive by the melancholy depres- 
sion of spirits and blue devils that inseparably ac- 
company them ? How many naturally mild and 
amiable tempers are rendered sour and irritable, 
and, at times, totally unfit for. society? How 
often is the once gay and buoyant spirit, which 
imparted cheerfulness and pleasure to the friendly 
circle, borne down by all the corporeal ills which 
the diseased imagination can paint ? How often is 
the man of business compelled to sacrifice the 
brightest prospects and most lucrative employ- 
ments, and driven an exile far from all the comforts 
and tender endearments of home, to recover the 
lost tone of his stomach ? Or, not possessing the 
means of travelling, after having swallowed half 
the preparations of the apothecary with no perma- 
nent benefit, and harassed and goaded on to despair 
as by an infernal fiend within his own bowels, looks 
to death as the only certain remedy for his suffer- 
ings ; and perhaps, at last, in some hapless moment 
puts a violent end to them — never suspecting that 



PREFACE. 



they might be removed by a proper diet and regi- 
men, and almost without the aid of medicine ? 

In consequence of repeated attacks of intermit- 
tent fever, and the great fatigue, irregular diet, and 
want of rest, inseparable from an extensive country 
practice, the author was for several years subject 
to a great variety of distressing symptoms, occa- 
sioned by indigestion. As may be supposed, he 
consulted the best treatises on the subject, and took 
almost every medicine recommended by them, but 
all without essential benefit. At last, fully con- 
vinced of the entire inefficacy of medicine without 
a suitable regimen, which his professional duties 
rendered impracticable, and anxious to get rid of 
the depression of spirits connected with his com- 
plaint, he relinquished business and embarked for 
Europe. He visited a large part of Great Britain 
and Ireland, resided some me in France, and tra- 
velled in Switzerland, Italy, and Sicily. During 
this time he enjoyed perfect health ; but as may be 
imagined, did not forget his former maladies : on 
the contrary, he spared no pains in examining the 
peculiarities of diet and habits of the people of 
the countries he visited, and the greater or less 
prevalence of indigestion among them ; in a w r ord. 
collecting all the information on the subject in his 
1* 



VI PREFACE. 



power. On his return home, he was soon revisited 
by his old enemy, which convinced him that the usual 
American mode of living would in a short time 
place him where he was when he left it, and that 
though he had acquired by travelling an exemption 
from his complaints, he had not altogether reco- 
vered the youthful tone of his stomach. A little 
admonition was sufficient : he at once regulated his 
mode of living upon principles which will be laid 
down in the course of this work, and has ever since 
enjoyed a degree of health which he believes is 
surpassed by few, if equalled by many profes- 
sional men. 

From what he has seen and experienced in his 
own person of a disease the most dreadful in its 
effects upon the temper, feelings, and spirits; a 
disease that seldom if ever obtains its due share of 
sympathy, because it is neither seen nor can be fully 
conceived by those who have never actually felt it, 
but is too often treated with unfeeling contempt, or 
aggravated by ridicule ; he is induced to present 
this little volume to the public in the hope of les- 
sening the sum of human suffering, and only re- 
quests the reader to give a fair trial to the rules it 
contains before he judges of their value, 



PREFACE. VH 

The time has been when it was customary for 
physicians to denounce all medical treatises intend- 
ed expressly for the general reader, upon the grounds 
that they can impart but an imperfect knowledge of 
the subject to which they are devoted, and are cal- 
culated to fill the mind of the invalid with false no- 
tions of his own case ; to encourage his tampering 
with medicine, and to give him unnecessary alarm 
by causing him to fancy that he has all the com- 
plaints which they describe ; finally, that it is the 
province of the medical man only, to think or reason 
upon the nature, causes, and treatment of diseases. 
That all this may be correct to a certain extent, 
will not be disputed. But shall we forego the count- 
less benefits of a general diffusion of knowledge, for 
fear that some few individuals will be rendered less 
happy by it ? Will any one have the hardihood to 
assert, that it is not desirable for every rational be- 
ing to be acquainted with the antidotes to poisons, 
and the best method of escaping contagion ? Or 
that the cause of humanity may not be served by 
pointing out the destructive tendency of drunken- 
ness, the diseases it produces, and the precise man- 
ner in which it produces them ? If it be desirable 
then that all should be instructed in these mattery 
is it not equally- so that the thousands who are 



VUl PREFACE. 

pining away with diseases, either produced or kepi 
up by the quality or quantity of their food or their 
habits or modes of living,should be made acquainted 
with the real causes? It is by the general diffusion of 
correct notions that the Journal of Health is render- 
ing an essential service to the community at large, 
and will doubtless accomplish much toward lessen- 
ing the labours of the physician, by preventing his 
prescriptions from being so often thwarted by the 
wayward prejudices of his patient. 

Though these pages are devoted to the general 
reader, the author hopes they will not be altogether 
unworthy the attention of his brethren of the pro- 
fession. 

New- York, 
:>5 Dominick-street, August, 1830, 



CONTENTS, 



INTRODUCTION. 



Description of the digestive organs ; mouth ; esophagus ; 
stomach ; intestines ; liver ; pancreas ; spleen ; nature 
and properties of the gastric juice and bile ; explanation 
of the digestive process ; names given to derangement of 
the digestive organs ; functional derangements divided 
into three species . ■ ix 



DERANGEMENT OF THE DIGESTIVE ORGANS. 

The savage and civilized man compared ; prevalence of de- 
rangement of the digestive organs among the different 
classes of society ; first symptoms of indigestion ; expla- 
nation of symptoms ; digestive powers of man weakened 
by refinement ; of animals by domestication 21 



FIRST SPECIES. 

Persons most subject to it ; symptoms ; explanation of symp- 
toms ; source of acidity ; stomach ; food ; opinions of 
Prout, Chevreul, Tiedemann, and Gmelin, and Leuret and 
Lassaigne on the nature of the acid ; effects of the acid 
on the stomach ; fermentation of the food ; acid increased 
by substances which irritate the nerves; stomach becomes 
morbidly irritable, and liver and bowels deranged .... 25 

SECOND SPECIES. 

Symptoms ; effects of unhealthy bile ; relief obtained from 
a cathartic .«,«..'. 34 



CONTENTS. 



THIRD SPECIES. 



First and second form ; symptoms ; great irritability of the 
stomach and bowels ; affection of the mind ; blue devils ; 
hypochondriasis, &c. ; danger to be apprehended from 
want of sympathy in the friends ; connexion between the 
digestive organs and mind ; sympathetic affection of dif- 
ferent parts ; poisonous influence of morbid bile ; peculiar 
appearance of the evacuations 39 

CAUSES. 

Extremely numerous ; divided into physical and moral ... 52 

PHYSICAL CAUSES. 

Effects of indulgence at a single meal ; too much may be 
oaten by eating too often ; consequences ; anecdote of 
Dr. Gregory ; indigestion m jre prevalent in America than 
in any other country '; difference of climate ; mode of liv- 
ing ; impression made upon strangers ; boarding-houses 
a source of indigestion ; American breakfasts ; eating 
without an appetite; fasting too long; effects of too 
hearty food , popular notions respecting animal food ; 
eating too fast ; spirituous liquors ; want of fresh air ; 
effects of intermittent fevers; habitual costiveness; to- 
bacco 54 



MORAL CAUSES. 

Grief ; disappointment, &c 81 

TREATMENT. 

Diet all important ; exercise 82 

TREATMENT OF THE FIRST SPECIES. 

Necessity of an appetite ; diet of animal food ; of bread, 
milk, &c. ; effects of each upon the author ; solid and 
fluid articles of diet ; milk ; gruel, &c. ; bread and milk ad- 
vised ; eggs and rice ; quantity to be eaten ; signs of hav- 
ing eaten too much ; drink; water the best ; time neces- 
sary to adhere to this diet ; medicine ; carbonate of soda ; 
carbonate of iron ; pills to prevent costiveness ; enlarging 
the bill of fare 8S 



CONTENTS. XI 



TREATMENT OF THE SECOND SPECIES. 

Diet ; oatmeal gruel ; bilious attack ; cathartics ; blue pill ; 
Sponging with water containing nitric and muriatic acid ; 
pain in the side, &c ; tonics ; state of the skin ; warm 
bath ; sponging with vinegar and water ; clothing . . . 10& 



TREATMENT OF THE THIRD SPECIES. 

Diet; state of the bowels; cathartics; lunar caustic ; a 
case; moral treatment ... . Ill 



CONCLUSION. 

Habitual costiveness ; cough ; white mustard seed ; sham- 
pooing ; waters of Saratoga and Balston ; travelling ; sea- 
voyage 119 

APPENDIX. 

Digestible and indigestible, relative terms ; animal food $ 
circumstances which render it digestible or indigestible ; 
boiling, roasting, and broiling ; baking and frying ; condi- 
ments ; salt, pepper, &c. ; fish , shell-fish ; eggs ; milk ; 
farinaceous food ; bread ; rice ; the potatoe ; fruits ; 
drinks ; toast-water and barley-water ; gruel ; coffee and 
tea: chocolate; cider; malt liquors ; wines ; spirits . .131 



INTRODUCTION. 



In order to be perfectly understood in the course of 
this work, I shall first give a brief outline of the pro- 
cess of healthy digestion, or" that change which our 
food undergoes in being converted into nutriment for 
the body ; referring those who wish to examine the 
subject more fully, to the systematic works on Physio- 
logy. The organs concerned in this process are, 1st, 
the mouth, the esophagus or gullet, the stomach, the 
small intestines and the large intestines, constituting 
one continuous tube of unequal dimensions in differ- 
ent parts, and called when taken together, the alimen- 
tary canal ; 2d, the liver, pancreas, and spleen. In 
man the length of this canal is five or six times that of 
the whole body ; in herbivorous animals it is compara- 
tively much longer, being adapted to the nature of their 
food, as its nutritious particles are so mixed with 
innutritious matters, that the whole must necessarily 
pass over an extensive surface before the former can 
be separated from the latter. In carnivorous animals? 
2 



X INTRODUCTION. 

on the contrary, it is shorter, as their food is more en* 
tirely converted into nutriment, of course when di- 
gested, more readily taken up by a smaller surface. 
Man holds a middle station, and is calculated to sub- 
sist on food of all sorts, or on vegetable or animal ex- 
clusively. Many savage nations in mild climates live 
on fruits and roots ; the Hindoo chiefly on rice and 
maize, without ever tasting flesh. On the contrary, 
others live almost entirely on the flesh and fat of ani- 
mals, as the Greenlander. Thus nature has wisely 
ordained that man, who inhabits every climate and 
quarter of the globe, should be enabled by the con- 
struction of his organs, to draw nourishment from 
almost every part of the vegetable and animal kingdoms 
to subsist amid the gloomy horrors of the polar regions 
upon the strong fat with which the animals of those 
seas abound, or broiling beneath an equatorial sun, to 
cool and refresh his system with the luxuriant fruits 
so profusely furnished at his hand. The esophagus is 
that portion of the alimentary tube extending from the 
mouth to the stomach. It is surrounded with muscu- 
lar fibres which, by contracting, convey the food to its 
lower extremity ; and it is lined with a soft membrane 
which secretes a bland fluid called mucous, which 
sheaths and protects the surface from the action of 
substances passing over it, at the same time lubricates 
them, and facilitates their passage to the stomach. 



INTRODUCTION. XI 

The stomach is compared in shape to a bent cone or a 
common powder-horn, with its large extremity placed 
in the left side, and its smaller extending towards the 
right. The esophagus opens into the large extremity, 
and this opening is called the upper orifice, while the 
place where the small extremity ends and the intes- 
tines commence, is called the lower orifice. It is 
composed of several coats or layers, the most impor- 
tant of which are the outer or smooth shining coat 
common to the stomach, intestines, &c. A middle 
coat composed of muscular fibres capable of contract, 
ing with considerable force, and an inner one of a soft 
delicate texture, imbued with mucous like that of the 
esophagus, and in which the vessels terminate, which 
secrete a peculiar fluid, called the gastric juice. The 
intestines are divided into small and large, the former 
being about four times as long as the latter, and have 
three principal coats resembling those of the stomach. 
The inner is also covered with mucous, and contains 
the mouths of a set of vessels called lacteals, whose 
office it is to take up the nutritious parts of the digest- 
ed food, and convey them to the blood. The first por- 
tion of the small intestines is named duodenum from 
its not exceeding twelve inches in length, is larger 
than the rest, its muscular coat thicker and stronger, 
and it has been called by some the second stomach, be- 
cause what is termed the second stage of digestion? 



XU INTRODUCTION^ 

takes place in it. The large intestines differ princi- 
pally from the small in being about twice as large, and 
are marked by muscular bands, which give the appear- 
ance of being divided into cells. The whole extent of 
this canal is abundantly supplied with nerves, but 
which, in a healthy state, (by a peculiar law of the 
animal economy governing all those organs necessary 
to life, and not subject to the will,) convey no distinct 
sensations to the brain. The upper orifice of the sto- 
mach is far more sensible than any other part of it, and 
is generally the seat of uneasiness when the stomach 
contains irritating substances. Connected with the 
alimentary canal, and the digestive process, is, 1st, the 
liver, (which it is unnecessary to describe,) which se- 
cretes the bile, and discharges it into the duodenum by 
the bileduct during digestion, and when not thus re- 
quired, into the gall bladder, or biliary reservoir ; 2d, 
the pancreas, a gland situated behind the stomach, 
which secretes a fluid not unlike saliva, and pours it 
into the duodenum along with the bile ; and 3d, the 
spleen, attached to the large extremity of the stomach, 
whose office is not perfectly understood. Before pro- 
eeeding to describe digestion, it will be necessary first 
to examine the properties of the gastric juice, and the 
bile, two important agents in this process. The gas* 
trie juice is, when pure and healthy, thin and transpa- 
rent, and not easily distinguished by the senses, from 



INTRODUCTION. Xlll 

saliva. In man, and most of the vertebral animals, it is 
asserted by some of the most respectable physiologists 
and chemists, to be slightly acid. It coagulates milk ; 
hence the curdled state in which it is often thrown 
from the stomachs of infants, and the use to which 
the stomach of the calf is applied in manufacturing 
cheese, is known to every one. But its most remarkable 
properties are its power of dissolving almost all sub- 
stances whether vegetable or mineral, and of counter- 
acting putrefaction. The gastric juice of the dog 
dissolves ivory and the enamel of the teeth ; that of 
many birds, the precious stones and the most insoluble 
of the metals ; even out of the stomach, it dissolves 
most kinds of solid food, if kept at the temperature of 
the body, as has been proved by numerous expert 
ments. Putrid aliment is immediately restored by it to 
a state of sweetness, and the most loathsome carrion 
a dog can be made to swallow, is soon found on open, 
ing him, to have lost all its putrescency. When we 
take into consideration the wonderful powers of this 
fluid, we are no longer astonished at many of the 
tricks of the mountebank, or the trifling inconvenience 
apparently experienced by the knife eater. The bile 
also acts a conspicuous part in the digestive process, 
and not unfrequently deranges all the organs concern- 
ed in it by its deviations from a healthy state. One of 
its peculiar properties is that of uniting with, and dis* 
2* 



Xl\ INTRODUCTION. 

solving fat or oil, which is the part of our food least 
acted upon by the gastric juice ; hence the use of ox 
gall in removing grease spots from cloth, and for other 
purposes to which it is applied in the arts. If a dog 
be made to eat food containing a large quantity of oil, 
and then killed and opened while digestion is going on, 
the oil is seen floating among the contents of the sto- 
mach, but is converted into a sort of soap by the bile 
in the duodenum. It neutralizes acids. As will be 
seen in the explanation of digestion, the food becomes 
slightly acid during this process in the stomach, but 
loses this character as soon as it receives the bile. It 
appears to be the principal agent in changing the 
chyme into chyle by separating the nutritious from 
the innutritious parts, so that the one may be taken 
into the circulation while the other is expelled, and 
probably its stimulating power keeps up the natural 
action of the bowels, and gives to the discharges 
their colour. 

The process of digestion is briefly this : — the solid 
food is first prepared for the action of the stomach by 
being masticated, or broken down and mixed with sali- 
va in the mouth. The necessity of mastication depends 
very much on the solvent power of the stomach. In 
some animals, as the dog, the food is swallowed in 
large morsels without chewing, and there are indivi- 
duals of the human species who can do the same with 



INTRODUCTION. XV 

impunity, at least for a time ; but in proportion as the 
human stomach differs from the canine in this respect, 
the necessity of thorough mastication is increased : in 
weak stomachs digestion cannot take place without it. 
When a full meal has been taken, the vessels of the 
stomach are excited to pour out the gastric juice, 
which commences dissolving the mass. According 
to Dr. Philip, this takes place to the greatest extent 
in the large extremity. A greater quantity of blood 
is drawn to the stomach from the rest of the body to 
supply the secretion, which in weak persons often 
occasions a slight feeling of chilliness, and the de- 
mand upon the brain for nervous energy produces an 
inclination to sleep. While the dissolving of the food 
is going on, for some time the lower orifice of the 
stomach is closed by the contraction of its muscular 
fibres ; thus preventing the undigested substances 
from entering the bowels, until the stomach begins to 
contract upon its contents, and gradually move the 
dissolved parts through this opening into the duode- 
num, when the upper orifice is closed, to prevent re- 
gurgitation into the mouth. The contractions of the 
stomach last till its contents are all expelled, which 
for an ordinary meal commonly takes four or five 
hours, and sometimes longer. The food, when it 
passes the lower orifice, has become changed into a 
soft pulp called chyme, and is decidedly acid, as ad- 



XVI INTRODUCTION. 

mitted by almost all modern physiologists. That the 
solution of the food is effected by the action of the 
gastric juice alone, has been satisfactorily proved by a 
great variety of experiments : among which, that of 
enclosing bits of meat in small metallic spheres, perfo- 
rated with holes, and swallowing them, should of it- 
self be considered conclusive, as the spheres are at 
last voided empty. The process as above described, 
is performed without any feeling or consciousness of 
what is going on, except a certain pleasurable sensa- 
tion which diffuses itself over the whole body. And 
here let me remark, whenever we feel our food after 
eating, or experience the least uneasiness from it in the 
stomach, we may be sure our digestion is not per- 
formed in a healthy manner. As soon as the chyme 
enters the intestines, it is mixed with the bile and pan- 
creatic fluid, by which it is rendered much thinner ; 
its acid is neutralized by the bile, and it takes the 
name of chyle. In passing through the small intes- 
tines, the fluid and nutritious parts of the chyle are 
taken up by the innumerable little vessels, called lac- 
teals, and conveyed to the blood to supply the wants of 
the system, and the remaining innutricious parts are 
carried into the large intestines, and after a short so- 
journ, discharged. This then is a hasty sketch of that 
exceedingly curious operation, by which we convert 
a vast variety of substances taken from the vegetable 



INTRODUCTION. XVli 

and animal kingdoms, into an integral part of our- 
selves. As the body is constantly undergoing a change, 
which may be called decay, it has as constantly need 
of a fresh supply of proper materials to keep it in 
repair ; and hunger and thirst are nature's monitors to 
warn us of this necessity, while the obeying their com- 
mands constitutes by far the largest proportion of the 
pleasurable sensations of existence. The various 
deviations from healthy digestion, or rather the 
derangements of the natural office of the digestive or- 
gans, have been called dyspepsia, indigestion, stomach 
complaints, bilious and nervous complaints, hypochon- 
driasis, morbid sensibility of the stomach and bowels,. 
&c. — all of which names are more or less applicable 
to certain forms of these derangements, without any 
one of them being proper to convey an idea of the 
whole. For though no great derangement of the 
function of one portion of the alimentary canal can 
long exist without in a greater or less degree affecting 
the others, by reason of the intimate connection sub- 
sisting through the whole extent, yet there may be 
considerable derangement of the stomach for a time, 
without materially implicating the liver or bowels, and 
on the contrary, derangement of these latter organs of 
the most melancholy kind, may exist without marked 
indigestion. It will at once be conceived that the func* 
tion (or office) of an organ must be deranged when 



XV111 INTRODUCTION. 

its healthy structure is altered by disease, which is 
called organic derangement. The function of an or- 
gan may also be deranged without any change in its 
structure, constituting functional derangement. Thus 
the function of the liver is to secrete a certain quan- 
tity of bile ; but from the action of a variety of 
causes without the least discoverable alteration of 
structure, it may form an undue quantity, and that of 
an unhealthly quality, which is derangement of func- 
tion. It is only of functional derangement of the di- 
gestive organs of which I propose to treat, and which, 
(though the symptoms characterizing the several kinds 
are variously combined and blended so as to form a 
vast variety of shades,) I have generally noticed un- 
der three distinct forms, as certain symptoms have 
predominated, and which for the sake of distinction I 
shall consider as three species. The first species is 
in a great measure confined to the stomach, and 
marked by symptoms denoting weakness of that or- 
gan, often existing without any material derangement 
of the liver or bowels. In the second there is a pre- 
dominance of symptoms termed bilious, with more or 
less derangement of the stomach and bowels. Both 
of these species are commonly called indigestion, 
dyspepsia, stomach and liver complaints, &c. The 
third is marked by symptoms indicating a morbid sen- 
sibility or irritability of the inner surface of the sto* 



INTRODUCTION. XIX 

mach and bowels. In some cases under this head, 
the digestive powers of the stomach are not percepti- 
bly impaired, but distant parts of the body and the 
mind suffer so severely from sympathy, as often to be 
mistaken for the seat of the disease. Under this spe- 
cies may be placed melancholy, hypochondriasis, and 
a long catalogue of complaints termed nervous. As 
I have just stated, the symptoms characterizing these 
species, may be variously combined. Thus the first 
and second species may exist in the same individual, 
or the second and third. But the great majority of 
cases may be arranged without difficulty under one or 
other of these heads, as the signs of derangement of 
the different organs predominate. 



DERANGEMENT 
OF THE DIGESTIVE ORGANS, 



" Health consists in regularity of the various functions ; disease 
in their irregularity ; death in their cessation." 



Man in the savage state is governed by the simple 
dictates of nature. The slave of no fixed rules, and 
regardless of particular periods, he satisfies his keen 
appetite with such food as comes most readily within 
his reach, and slakes his thirst at the first running 
stream. Accustomed to the inclemencies of the 
seasons from his earliest moments, his frame like the 
oak of his forests, acquires by exposure the maximum 
of strength, and his nerves are braced to the most se- 
vere exertions. A stranger to lingering complaints, 
he feels no pains but from fatigue, no uneasiness but 
from hunger and thirst, and is at last promptly cut off by 
some acute malady, or falls by the casualties of war 
or the chase. But what a striking reverse of all this 
is presented by civilization and refinement. The dic- 
tates of nature are either stifled or disregarded, the 
palate is coaxed and pampered by every variety and 
delicacy the inventive genius of man can conceive, 
3 



22 DERANGEMENT OF THE 

and the pure spring gives place to the fermented 
draught, the rich juices of the grape, or the more per- 
nicious products of distillation. Cautiously protected 
from the weather during infancy, and fostered by the 
tender hand of misplaced affection, the system be- 
comes sensible to the most trifling changes, and shrinks 
from every puff of wind. The diseases to which it is 
subject are rendered doubly frequent, and new ones 
produced ad infinitum, and the outlets of life are in- 
creased so thick about us, that it is only astonishing we 
escape death so long. But above all, the class of dis- 
eases now under consideration, is occasioned entirely 
by the diet, habits, and modes of life introduced by 
civilization, and is never known in the savage state. 
The careful observer may trace it from the cottage of 
the hardy labourer, where it is comparatively, but sel- 
dom found advancing 'pari pas&u with refinement 
through all the different grades of society, to the pa- 
lace of the rich, where he meets it at every step. 
With the peasant it is generally the consequence of 
vice and intemperance. The mechanic is often its 
victim from confinement and bad air, it lies con- 
cealed among the rich viands of the opulent, presides 
at the nocturnal orgies of the bacchanalian, hovers 
about the student's midnight lamp, and is the insepa- 
rable companion of grief and disappointment, and 
every kind of immoderate mental excitement. An 
immense proportion of that class of the community 
not actually engaged in any laborious employment. 
and many of those who are, experience after eating, 
(though in moderation,) certain ordinary articles of 
food, a feeling of uneasiness at the pit of the stomach. 



DIGESTIVE ORGANS. 23 

This uneasiness occasions an inclination to swallow 
and expel air, or what is termed belching. The air 
thus expelled is often hot and acrid, not unfrequently 
bringing along with it a little pungent acid fluid, and a 
sensation of heat or burning is perceived in the sto- 
mach. This is what is understood by heartburn, and 
usually subsides in a little time, or yields to a glass of 
cold water or some other trifling remedy. At other 
times the uneasiness is more considerable, and at 
some of these efforts to belch, a large quantity of hot, 
acid, or bitter fluid is thrown up with some temporary 
relief. If the food taken happens to have been fat or 
oily, as fresh pork or roasted duck, it imparts its pe- 
culiar flavour to the eructations which generally con- 
tain more or less oil, and small portions of undigested 
food. The stomach feels inflated, and gas is dischar- 
ged upward at intervals, with momentary relief. Some- 
times the disturbance going still further, a retching is 
excited, and a portion, or perhaps the whole of the 
contents of the stomach are thrown up. The appe- 
tite is but little, if at all impaired for the next meal, 
and the same thing does not again occur till produced 
by a similar cause. There are other persons, who in- 
stead of the foregoing phenomena, experience pain of 
the head, restlesness, general uneasiness, sense of 
weight at the stomach, and a thousand indescribable 
feelings from the same cause. When there are many 
articles that disagree in this way, the person, though 
in every other respect healthy, is said to have a weak 
stomach. The explanation of all this is very simple* 
We have seen in the introduction, that the stomach, 
possessing its natural power, dissolves readily almost 



24 DERANGEMENT OF THE 

all kinds of food : but it is enervated by refinement 
as well as most other parts of the animal machine, and 
consequently we find, that in many individuals the gas- 
tric juice is not sufficiently strong to dissolve certain 
kinds of food, or in other words, they are too indi- 
gestible for them. Manv of the animals we have do- 
mesticated, show the same diminution of the energies 
of the stomach. For instance, my lady's pet dog, 
that never quits her side, is sure to be sickened by 
feeding upon the food which his more hardy brother, 
the companion of the peasant, takes with impunity. 
If the food is not readily digested from the effects of 
combined heat and moisture, it runs into speedy fer- 
mentation. Gas is disengaged, and inflates the sto- 
mach; acid is generated, and the fat or oil of the food, 
of which the fluidity is increased by the elevated tem- 
perature, rise to the upper part of the stomach mixed 
with the acid matters, and irritating the superior ori- 
fice, the most sensible part of the organ, occasion all 
the phenomena just mentioned. Exactly the same 
effects will be produced in the same individuals by 
overloading the stomach with food, which it can easily 
dissolve when taken in moderate quantity. For then 
it is too much distended to contract properly upon its 
contents, and is unable to furnish the quantity of gas- 
tric juice required. Of course, fermentation and its 
unpleasant consequences must follow. Sometimes 
there are portions of the food from not being suffi- 
ciently masticated, that are neither dissolved by the 
gastric juice, nor undergo fermentation ; such as bits 
of apple and other fruits, and are at last discharged 
unchanged, after occasioning more or less disturbance 



DIGESTIVE ORGANS. 25 

in the bowels. When from the operation of causes 
which will be treated of in the sequel, acidity, heart- 
burn, or -uneasiness of any kind, is constantly experi- 
enced after eating, the person is said to have indiges- 
tion or dyspepsia. The same names are commonly 
given to a great variety of distressing affections, some 
way connected with the digestive process. 

First Species. 

The first species occurs in persons of all ages after 
puberty, in all classes of society, though by far the 
most frequently among those in easy circumstances ; 
oftener in females than males, and is peculiarly the 
scourge of those devoted to literary pursuits. It some- 
times continues for years with periods of trifling 
amendment, and relapse without seriously effecting 
the general health, or materially impairing the consti- 
tution. Its most striking features are^ almost incessant 
dull headach, flatulence, an uneasy gnawing sensa- 
tion in the stomach whenever it is empty, and con- 
stant acid eructations after eating. In the morning 
there is often an unpleasant taste in the mouth, and 
the tongue is slightly coated, especially near the 
root. If the breakfast is deferred for an hour or two, 
there is dull pain over the eyes, a gnawing feeling in 
the stomach, and occasionally a great flow of saliva 
into the mouth, which is swallowed every moment, or 
induces constant spitting. This last symptom is rarely 
noticed, unless the dyspeptic is a very attentive obser- 
ver of his own feelings, or is questioned respecting it, 
but will be very frequently found to accompany great 
3* 



26 DERANGEMENT OF THE 

acidity. The breakfast, if not too early, is eaten with 
tolerable appetite ; but in half an hour, the mouth is 
again inundated with saliva, there is a sensation, as 
if some hard body were contained in the stomach, or 
as if it were distended with confined air ; and the in- 
valid can scarcely refrain from swallowing air, and 
belching it up again. At length, a considerable quan- 
tity of hot, acrid, ropy fluid is brought up, watery and 
acid if the breakfast has been only bread or toast, 
with tea or coffee and thick and oily, if of animal 
food. There is a hot uncomfortable feeling in the 
stomach, and what is brought up. is often so acrid as 
to occasion smarting of the throat. Not much of the 
solid food is ejected by these eructations,unless a large 
quantity of drink has been taken, noris nausea or vomit- 
ing often excited. After a meat breakfast, the forehead 
often feels hot and painful, with general listlessness, 
and aversion to exercise, though this is not constant. 
These symptoms usually last for an hour or two, and 
then subside. If there is an interval of five or six 
hours between breakfast and dinner, the headach and 
uneasiness in the stomach return. Sometimes there 
is a sense of coldness in the stomach, and sometimes 
heat is felt flashing from the stomach to the bowels, in 
a manner quite indescribable. The dinner is eaten 
with more or less appetite, in proportion to the time 
that has elapsed since breakfast, and the exercise 
which has been taken ; and if not too fluid or oily, is 
the meal of all others, that sits best on the stomach. 
On the contrary, if it be made up of rich soups, articles 
containing drawn butter, or much oil, as ducks, geese, 
fresh pork, &c, and a great quantity of any fluid, att 



DIGESTIVE ORGANS. 27 

the symptoms which followed the breakfast return, and 
often in a greater degree of severity. If the stomach 
has been roused to digest the articles enumerated, by 
a liberal use of strong wine or brandy, there will be 
less disturbance for the time ; but the dyspeptic com- 
monly pays for it next day with interest. Drowsiness 
and heaviness of the head usually follow a dinner, 
that from its quality or quantity is difficult of diges- 
tion. After four or five hours, tea, and a bit of toast, 
or bread and butter are taken, not exactly with what 
may be termed appetite, but an uneasy gnawing feel- 
ing at the stomach, usually mistaken for appetite, and 
is often the cause of a renewal of the eructations, &c. 
If supper be eaten, the invalid soon finds himself hot 
and restless after going to bed ; is tormented with fla- 
tulence and eructations, and after a wretched night of 
tossing from side to side, and little or no sleep till to- 
wards morning, rises with headach, furred tongue, 
thirst, and other feverish symptoms. Notwithstanding 
all this disturbance in the stomach, the bowels often 
continue nearly regular, and the action of the liver 
not seriously deranged, particularly in those who spit 
up the offending fluids most freely. For though this is 
an unpleasant symptom of itself, I have remarked that 
they suffer less than those who have all the other 
signs of acidity, without the copious eructations, for in 
them the irritating matters passing through the bow- 
els, occasion much more derangement ; such as colic 
pains, diarrhoea, alternating with costiveness, &c. 
Persons affected in this manner, are commonly thin, 
but not greatly emaciated ; though I have seen them 
in hundreds of instances retain a tolerable degree of 



28 



DERANGEMENT OF THE 



plumptness for years, and with a complexion not indi- 
cative of decidedly bad health. Among females, there 
is often a craving for chalk, pipe clay, magnesia, and 
similar articles. The teeth are generally disposed to 
be coated with tartar, and sometimes loosen and fall 
out without any marks of decay. Feelings called 
nervous, such as fluttering and palpitation of the heart, 
and trembling of the hands when agitated, are not un- 
common. In this, as well as the other species, nothing 
is more common than pain, occasional giddiness, and 
a great variety of strange confused sensations in the 
head. These are sometimes imputed to fullness of 
blood in the head ; and I have known bleeding, blisters, 
scarifying and cupping the temples, &c, to be pre- 
scribed for months in succession, when the stomach, 
though little suspected, was alone the seat of the diffi- 
culty. Other troublesome symptoms are a sense of 
heat or burning in the stomach, and an uneasy aching 
feeling in the back of the neck, sides, and parts adja- 
cent, occasioned by the action of acrid matters upon 
the nerves of the stomach. The gnawing sensation is 
owing to the same cause, and is often mistaken for 
hunger, inducing the dyspeptic to take food when the 
stomach is not prepared to receive it ; which of course, 
not being well digested, increases the evil. The flow 
of saliva into the mouth, is occasioned by the glands 
connected with it sympathising with the stomach. 
There are some who suffer considerably from acidity, 
and the* fermentation which the food undergoes from 
lingering too long in the stomach, without being con- 
scious of it, as they seldom bring up any thing by 
eructation. They. complain of flashes of heat in the 



DIGESTIVE ORGANS. 



20 



stomach and bowels, almost constant flatulence, and 
desire to belch before and after meals, and a gnawing 
at the stomach when it is not full. They say they 
have no want of appetite ; on the contrary, they gene- 
rally think they have too much, but feel as if they 
had eaten too much after almost every meal. They 
can easily be convinced that their unpleasant feelings 
arise from acid in the stomach, by taking a solution of 
carbonate of soda, which is immediately decomposed 
by the acid uniting with the soda, and the disengaged 
carbonic acid gas rushes up through the nose. On 
the other hand, those who have most frequent acid 
eructations, say that every thing turns sour on the sto- 
mach. After a dish of coffee, or tea only, in the 
morning, more than a pint of acid fluid will be spit 
up, often so pungent as to act upon marble. Indeed, 
I have been told that a glass of cold water wottl^ 
become sour, and be brought up in ten minutes after 
drinking it. In this case, the water by uniting with 
the acid already in the stomach, and bringing it more 
in contact with the upper orifice, (the most sensible 
part of the organ,) occasions so much irritation, as to 
give rise to the effort to bring it up by eructation. 
Sometimes little or nothing is brought up by eructa- 
tions ; but the acid produces a great deal of gnawing 
in the stomach, which is often expressed by the inva- 
lid, as a sense of faintness, and attacks of intolerable 
periodical headach, usually about a certain hour in the 
day. These headachs not unfrequently pass for what 
are called nervous, and their real cause is overlooked. 
Nothing can be more hurtful to a weak stomach, than 
this peculiar acid which it contains, and it is curious to 



30 DERANGEMENT OF THE 

mark the regular, though gradual manner in which it 
increases, as the tone of the organ becomes more and 
more impaired. First, it is only perceived occasionally 
after eating certain kinds of food, then frequently 
after breakfast; at length, almost constantly after 
every meal, and finally whenever either food or drink 
is taken. It may with propriety be asked, what is the 
origin of this acid ? the food undergoing fermentation, 
or the stomach ? Undoubtedly both. First, it is admit- 
ted by most modern physiologists, that healthy gastric 
juice contains a notable quantity of free acid, and 
that the fluids secreted by many weak stomachs, con- 
tain this acid in very great excess. That by far the 
largest part of it does not arise from fermentation, may 
be satisfactorily proved by a variety of experiments. 
For instance, if nothing be tasted for a time, but ani- 
mal food, which does not readily undergo fermentations, 
say fat bacon, the quantity of acid, instead of decreas- 
ing, will be astonishingly increased. On the other 
hand, it will be perceptibly diminished by subsisting 
entirely for a few days, on some digestible article 
from the vegetable kingdom that readily ferments ; say 
for instance, good stale bread. But chemical analysis 
puts this question at rest. It demonstrates the acid to 
be one that is not formed by fermentation, and physio- 
logists generally attribute it to some process peculiar 
to the system of the living animal. With regard to 
its precise character, some diversity of opinion still 
exists. Dr. Prout of Great Britain, after a great 
variety of experiments, has pronounced it to be the 
muriatic. Chevreul and some other French chemists, 
have considered it to be the lactic* Some years since 



DIGESTIVE ORGANS. 31 

the Parisian Academy offered a prize for the best 
experimental essay on digestion. Two were pre- 
sented, the one by Tiedemann and Gmelin, (Germans,) 
and the other by Leuret and Lassaigne, (French.) 
Both were thought so meritorious, that they obtained a 
reward of fifteen hundred francs each. Tiedemann 
and Gmelin maintain that the acid is muriatic, and 
Leuret and Lassaigne, that it is lactic. Both agree 
that when the gastric juice is secreted in consequence 
of the stimulus of food, the chymous mass is always 
acid, and the former assert that the acidity is greater 
in proportion to the indigestibility of the food. Some 
have supposed the acid to be the phosphoric ; among 
whom may be mentioned our countryman, the late Dr. 
Young of Maryland. To enter into an elaborate exam- 
ination of their several opinions, would be foreign to 
the objects of this work. It is sufficient for the pre- 
sent purpose, if they go to prove that the stomach may 
be the principal cause of acidity. When acid exists 
in any great degree in the stomach, it irritates its 
nerves, and probably occasions the secretion of an 
unnatural quantity of the thin mucous, the use of which 
is to sheath and protect the surface upon which it is 
poured, and which, either by adding to the quantity of 
acid, or by diluting the gastric juice too much, and 
thus rendering it inefficient, undoubtedly increases 
the difficulty. Secondly, the food from remaining too 
long in the stomach, whether from weakness of the 
gastric juice, or a languid contraction of the muscu- 
lar coat of this organ, in consequence of the combin 
ed action of heat and moisture, may ferment, and 
generate acid which is most probably the acetic, that 



32 DERANGEMENT OF THE 

being the usual product of fermentation. Whether 
the acid arises then from one or both of these sources, 
the fault lies in the stomach, and its contents retaliate 
upon it, and thus render it weaker and less able to 
secrete a healthy juice ; so by the unhealthy action 
of the stomach, and the reaction of its contents, every 
thing goes on from bad to worse. We have already 
seen that the stomach generally has but little sensi- 
bility ; for this reason, when it is nearly empty, the 
irritation of the acid only occasions the gnawing feel- 
ing, so difficult to be distinguished from hunger. But 
when food or drink is taken, the acid is applied by it 
to the upper orifice, and produces the uneasiness 
heretofore described. 

It must not be forgotten that the mere presence of 
a certain quantity of acid in the stomach, is not of 
itself sufficient to occasion the distressing symptoms I 
have enumerated ; for the food always becomes acid 
to a certain degree during the digestive process, and 
continues so till it receives the bile : but it is to an 
undue quantity that they must be attributed, and this 
undue quantity it is very likely depenSs upon some 
peculiar condition of the nerves of the stomach, which 
it is impossible to explain. This may be fairly inferred 
from the effects of certain articles, the operation of 
which is principally upon the nervous system. Thus 
green tea, coffee, wine, &c. greatly increase the 
quantity of acid. I have known persons to throw up 
from half a pint to a pint of acid, sufficiently strong 
to act readily upon a marble slab after drinking a cup 
of coffee in the morning without any food ; and 1 have 
known a considerable quantity to be brought off the 



DIGESTIVE ORGANS. 33 

stomach in the morning after having taken two or 
three glasses of wine just before going to bed. I 
have often suffered exceedingly from acidity in the eve- 
ning, after a dish of strong green tea. Another article 
that invariably has this effect, is the empyreumatic oil 
produced by frying meat. Thus the same meat, as 
ham, if fried will occasion intolerable acidity, when it 
sits tolerably well on the stomach if boiled. 

After a time the stomach acquires an unnatural 
degree of sensibility or irritability, and suffers more 
from the action of the acid, or from the presence of 
improper food. In proportion as this increases, the 
gastric juice becomes more and more unhealthy and 
inefficient. At length the function of the liver may 
become deranged, particularly if no attention be paid 
to diet, giving rise to a long train of distressing 
symptoms, and very soon disordering the bowels, if 
they have not suffered already. The stomach, instead 
of being relieved, is still further weakened by the dis- 
turbance in the functions of the liver and bowels, and 
thus link after link, the whole chain of digestive 
organs may be involved in diseased action, which has 
commenced in a single one. The season of the year 
has apparently but little effect upon this species, as it 
is nearly the same in winter and summer, nor is it 
influenced by the quantity of exercise the invalid 
takes, so much as the other species, for it does not 
entirely subside during a long journey, as they com- 
monly do. But the digestible or indigestible nature of 
the food produces the most evident effects. Thus a 
perfectly ripe mellow peach, which is easily digested, 
will occasion no marked increase of acidity, while a 
4 



34 DERANGEMENT OF THE 

hard unripe one, which cannot be sufficiently dissol- 
ved to ferment, but passes through the bowels entirely 
unchanged, will occasion a great abundance. This is 
another evidence that the acid principally comes from 
the stomach. 

Second Species. 

We have seen that the first species, in its early 
stages at least, is principally confined to the stomach, 
and most of its symptoms occasioned by acidity. In 
the second species the leading . features are more or 
less connected with derangement of the biliary func- 
tion and imperfect digestion. The invalid labouring 
under this form is commonly worst in the spring of 
the year ; suffers from occasional attacks, termed bili- 
ous, during the summer, and experiences some ameli- 
oration of his complaints as the cold weather sets in 
and during the winter. Sometimes for a few days he 
enjoys tolerable health, and again, without any appa- 
rent cause, may be too ill to leave his bed. Some- 
times he is able to attend to business, and at others is 
incapacitated for making the least exertion. Thus he 
is constantly fluctuating from one point of the scale 
to the other, but rarely feels perfectly well. 

When he first rises in the morning he is languid 
and listless, with more or less pain in the head, a bit- 
ter disagreeable taste in the mouth, and the tongue 
covered with a yellowish fur, particularly towards the 
root. He frequently complains of loss of taste ; has 
but little appetite for food, and is oppressed and un- 
comfortable after his meals. After eating hearty food 



DIGESTIVE ORGANS. 35 

he often feels as if he had swallowed some hard angular 
substance ; his forehead is hot and something painful ; 
he has throbbing of the temples, back of the neck, 
pit of the stomach, and is more inclined to lounge 
about than to make any exertion of body or mind. 

Though heavy and inclined to sleep during the day, 
his nights are usually restless ; his sleep is disturbed 
by frightful dreams, or occasional visitations of the 
nightmare, and he awakes feverish and thirsty. Now 
and then he has attacks of giddiness, often followed 
by slight faintness or sickness at the stomach. He 
has vague pains and sense of weariness in all his 
limbs, almost constant aching in the back and loins, 
and sometimes a soreness or sort of lameness in the 
motions of the eye. Pains are often felt at the tip of 
the shoulder, between the shoulders, in one or both 
sides, increased by a deep inspiration, and in the back 
of the neck. Sometimes there is tenderness or a burn, 
ing sensation at the pit of the stomach, or in the right 
or left side ; numbness of the right side and arm, and 
inability of lying on that side. The skin in the worst 
cases is not soft and perspirable, but has, a hot greasy 
feel, particularly upon the forehead. The complexion 
is of a dingy sallow hue, and the eyes, which almost 
always have a very heavy expression, are occasion* 
ally of a yellow tinge. 

The bowels are seldom regular, generally torpid and 
confined, though sometimes relaxed for a day or two, 
when the evacuations are exceedingly bilious. The 
urine is high-coloured and deposits a reddish sediment 
upon the bottom of the vessel. There is often great 
logs of flesh and strength. Indeed, it is remarkable 



36 DERANGEMENT OP THE 

that very considerable derangement of the stomach 
alone may exist for a long time without any thing like 
excessive emaciation ; but when the biliary system 
suffers, the loss of flesh and strength is often astonish- 
ingly great. In addition to the real weakness of the 
invalid, occasionally a feeling of entire prostration of 
his muscular powers comes over him, and then the 
least motion is with reluctance : to ascend a staircase, 
walk across the room, or even stretch out his arm to 
help himself to the smallest thing, seems impossible, 
when perhaps in a few hours he is able to walk a mile 
without great fatigue. 

The temper becomes irritable and impatient, even 
in those naturally the most amiable, and there is a 
marked aversion to society, most kinds of conversa- 
tion, and every thing gay or cheerful. But the symp- 
tom above all others the most truly distressing, is a 
depression of spirits which no fortitude can resist, no 
philosophy bear up under. Even when the invalid 
perfectly understands its cause and the nature of his 
complaint, and is entirely convinced that nothing 
alarming need be apprehended, there is a gloomy 
boding of danger that irresitibly weighs him down to 
the earth. He feels best after several hours fasting, 
and fancies he would be quite well if he could live 
without eating ; but all his bad feelings are revived by 
the next meal, and he is driven almost to despair by 
the melancholy idea that the nourishment nature re- 
quires is, when taken, the cause of all his sufferings. 

As I have already intimated, there is not unfre- 
quentiy a combination of many of the symptoms of 
this and the first species, though generally those of 



DIGESTIVE ORGANS. 37 

one or the other predominate. To describe all the 
varieties which present themselves would be little less 
than giving a history of every separate case. Hardly 
any two are precisely alike, and there is no end to the 
sympathetic affections of different parts of the body ; 
and the thousands of strange and to the invalid unac- 
countable feelings which he will at times experience. 
Hundreds have more or less of the above symptoms 
without labouring under the aggravated form of the 
disease I have described, and the endless shades of 
difference in the severity of different cases may be 
noticed from the occasional feeling of heaviness or 
load at the stomach within twenty-four or eight and 
forty hours after eating certain kinds of food, without 
any very obvious fault in the digestive process, (and 
which, by the by, should be a hint to those who are 
subject to such visitations), to the most melancholy 
stage of the complaint, entire prostration of strength, 
excessive emaciation, inability to digest without unea- 
siness, even the lightest solid food, and a mind borne 
down by a horrid load of gloomy bodings, but little 
preferable to madness. In addition to a weak state 
of the stomach, many of the phenomena exhibited in 
this species, depend upon derangement of the biliary 
function, as those of the first do upon acidity. We 
have noticed in the Introduction, the important part 
performed by the bile in completing the transformation 
of food to chyle, and it will at once be conceived that 
a deficiency of this fluid, or any deviation from a 
healthy state, must materially affect the digestive pro- 
cess. In some cases a large quantity of unhealthy 
bile is accumulated in the gall bladder and biliary 
4* 



33 DERANGEMENT OF THE 

tubes, of course is not regularly mixed with the dis- 
solved food ; in others it probably so far loses its natu- 
ral character as to be incapable, after it reaches the 
duodenum, of mixing with it, and is accumulated in 
the bowels, till by its irritation and regurgitating into 
the stomach a fit of sickness and vomiting is occa- 
sioned, when it is thrown up in great quantities, often 
as thick as jelly ; or a diarrhoea is brought on, and it 
is discharged by the bowels. When it is not regu- 
larly poured into the duodenum, its thin parts are ab- 
sorbed and carried into the circulation, giving to the 
complexion the sallow T tinge ; and the thick tenacious 
parts remaining, are entirely unfit for the purposes for 
w r hich the bile is intended. It is sometimes so acrid 
as to blister the skin when applied to it, and then un- 
doubtedly produces a great variety of painful and dis- 
tressing sensations, as pain in the head, uneasiness 
and pain in the sides, pit of the stomach, shoulders, 
&c. If from any cause whatsoever it is prevented 
from uniting in suitable quantity with the chyme, 
healthy chyle is not formed, and the system being 
thus deprived of its proper nourishment, great loss of 
f.esh and strength speedily follow. The confined 
state of the bowels may be attributed to the same 
cause. The depression of spirits, feeling of weari- 
ness in all the limbs, soreness in the motions of the 
eyes, pain in the back, and a vast number of other 
uneasy sensations, are owing to the effects of morbid 
bile upon the nervous system, as well as the flashes of 
heat, throbbing of different parts of the body, restless 
nights, &c. Now and then the irritation is so great 
as to excite fever, thirst, furred tongue, violent pain in 



DIGESTIVE ORGANS. 39 

the head or side, and a great variety of other symp- 
toms. All these things impair the solvent powers of 
the stomach ; what is taken into it is not properly 
changed into chyme, and from the defect in the bile 
lingers too long in the bowels, is more or less subject 
to chemical changes, and thus becomes another source 
of irritation. If the invalid now takes an active cathar- 
tic, which commonly dislodges an immense quantity 
of offending matters, he is perfectly relieved for a 
time. His natural cheerfulness returns ; his appetite 
improves, and his fondness for exercise and amuse- 
ment revives. But this period of exemption from his 
complaints, particularly if he pays no attention to diet, 
is very breif — accumulations gradually take place in 
the bowels, and with them all his ailments are again 
renewed. 

Third Species. 

The third species depends upon a morbid sensibility 
or irritability of the inner surface of the stomach and 
bowels, with more or less derangement of the functions 
of the liver. It appears under the following forms, — 
1st, with marked indigestion, or painful digestion, and 
2d, with obscure symptoms of indigestion, or without 
any very obvious signs of it. When there is marked 
indigestion, more or less uneasiness, often amounting 
to pain, is experienced in the stomach after eating 
many kinds of solid food. High seasoned articles, 
wine or spirits, indeed every thing of a stimulating 
nature, occasion more or less distress in the stomach, 
and in almost every case a rending pain in the head* 



40 DERANGEMENT OF THE 

The stomach is so morbidly sensible, that any solid 
substance, such as a crust of bread, a bit of hard 
apple, even a hard pill is felt for a long time after it is 
swallowed. I have known the most exquisite suffering 
produced by the seed of an orange, swallowed by ac- 
cident. In the worst cases of this form, the secretion 
of gastric juice seems to be almost entirely suspended, 
as nothing but the mildest fluids can be digested. 
When solid food is taken, it is distinctly felt in the 
stomach, the head begins to ache, and soon becomes 
distracting, the temples throb, the heart palpitates, and 
the whole nervous system seems agitated and disturb- 
ed. At length, the headach becomes so intolerable 
as sometimes to occasion fits of fainting and insensi- 
bility, till at last nausea and vomiting take place, and 
the food is thrown up as undigested as at the moment 
it was swallowed. I have known a small quantity of 
fresh fish to give rise to a paroxysm of this sort, and be 
brought up after many hours of the most dreadful tor- 
ture, as entire as when eaten ; a little wine, a bit of 
apple, a pill, even beef tea, had the same effect. — 
When it arrives at this stage, the head is seldom if 
ever, free from pain; solid food is rejected without 
the least acidity or change of taste or appearance, 
after remaining for hours in the stomach, the bow- 
els are torpid, the strength and flesh waste rapidly, the 
complexion is dingy, the nights are sleepless from 
burning of the hands and feet, or pains in various 
parts, or passed between unrefreshing dozing, and the 
most frightful -dreams, and the days are embittered by 
unceasing pains. The function of the liver is gene- 
rally very much deranged, occasioning pains in the 



DIGESTIVE ORGANS. 41 

side, an occasional slight hacking cough, pain, and 
sense of great weariness of the back, loins, and / 
limbs, aversion to exercise, listlessness, gloominess of 
mind, and dejection. The most trifling thing frightens 
and agitates, the heart beats violently against the ribs, 
the hands tremble, hearing and vision become pain- 
fully acute, and ascending a few steps excites flutter- 
ing and breathlessness. The pulse is quick, some- 
times soft and sometimes wiry. There is little or no 
appetite, occasional thirst, tongue coated in the mid- 
dle, and red at the edges. The bowels are often so 
irritable, that the smallest quantity of cathartic raedi- 
cines, as a teaspoon-full of Epsom salts-, acts most 
violently upon them, and occasions great pain and 
uneasiness. From a dread of which, the invalid omits 
taking them as long as possible, and allows the bowels 
to remain confined, by which the bile and other secre- 
tions are accumulated, enter into new chemical com* 
binations, and thus become a new cause of irritation* 
To these symptoms may be added a vast number of 
others called nervous, differing in degree and kind in 
almost every individual. In the 2d form, (by far the 
most melancholy of all the derangements of the diges- 
tive organs,) there may, or may not be symptoms of 
indigestion. It is known by the names of low spirits, 
blue devils, hypochondriasis, melancholy, &c, and 
exhibits a vast variety of varying shades, from the 
transient fit of despondency, to a state of mind the 
most exquisitely dreadful, differing but little from real 
madness. In the first species, we have seen the sto- 
mach engrossing the principal attention, in the second, 
the liver, and again in the form of this species just 



42 DERANGEMENT OF THE 

described, the stomach is referred to as the seat of the 
complaint ; but in this the wretched sufferer is often at 
a loss where to fix his disea'se. In the sequel I think it 
will be evident that the inner surface of the bowels 
having become morbidly irritable, is the real seat of the 
disease, and that it occasions through the medium of 
nervous sympathy, a great variety of affections of 
different parts of the body, as the brain, lungs, heart, 
urinary organs, limbs, &c, or vents its whole force on 
the mind. The persons most subject to this form, are 
generally past the meridian of life, who have been 
actively engaged in business calculated to produce 
anxiety or requiring constant exercise of the mind. 
Those who have made fortunes in warm climates, and 
have returned to the north to spend the evening of 
their days, are peculiarly obnoxious to it. In some 
cases there are flatulence, eructations, feeling of dis- 
tention and weight at the stomach after eating, irregu- 
lar bowels, &c. In these, the invalid is convinced his 
digestion is bad. In others, none of these symptoms 
are present, or if so, in a trifling degree, and are 
entirely unnoticed. Sometimes they do exist to a cer- 
tain extent, but are overlooked in anxiously attending 
to the sympathetic affection of some other part. — 
Sometimes the head is affected with giddiness* and 
great confusion of ideas, ringing of the ears, and 
indistinct vision. Sometimes the action of the heart 
becomes exceedingly irregular, throbbing and beating 
violently against the side, now and then intermitting, 
and occasioning great distress, and an irregular and 
intermitting pulse. Sometimes there is severe smart* 
ing and pain in voiding the urine, which is often scanty. 



DIGESTIVE ORGANS. 43 

turbid, and high coloured, and cannot be retained but 
for a few minutes at a time, or abundant and perfectly 
colourless ; but to attempt to enumerate all the strange 
affections that appear in this form, would be to give a 
history not only of most of the complaints called ner- 
vous, but of one half the diseases that affect the 
human frame, for Proteus like, it imitates a very large 
proportion of them. But there is one symptom that is 
never wanting, and that is the most dreadful mental 
dejection, and disposition to magnify every unpleasant 
feeling, to look upon the above mentioned affections 
as incurable and fatal diseases, and a constant appre- 
hension of some overwhelming calamity. Every feel- 
ing is most carefully and anxiously noticed and greatly 
exaggerated by the morbid sensitiveness of the mind, 
If there are dizziness and ringing of the ears, the inva- 
lid is sure he is threatened with apoplexy or palsy. 
If he coughs, he dreads a rapid consumption, his 
heart palpitates, and he feels his pulse and finds it 
intermitting, and is convinced he has disease of the 
heart, which will speedily destroy him. If his urine 
is scanty and high coloured, and he has smarting and 
pain in voiding it, he fancies he has gravel or stone, or 
if it is abundant and limpid, he is certain of diabetes. 
To add to his torments, his friends, who little suspect 
the hundredth part he suffers, because they see nothing 
which to them is indicative of disease, laugh at his 
complaints, or attempt to convince him that he is in fact 
intolerable health. But as well might they have con- 
vinced the wretched Mexican, writhing upon the heated 
gridiron, that he was reposing upon a bed of down. 
His complaints are not imaginary, he feels that they 



44 DERANGEMENT OF THE 

are but too real, and this inhumanity in those who 
should endeavour to alleviate his sufferings, increases 
the gloom that broods over his spirits, and greatly 
aggravates every symptom. " Their complaints," 
says Dr. Johnson, " are considered imaginary, and 
pass unpitied ; and the unhappy victim of a real phy- 
sical malady which preys on his vitals, is thus set 
down as a hypochondriac, and so bantered and ridi- 
culed by his friends, that the world is to him a purga- 
tory from which he has little regret in parting." 

There is good reason to believe that very many, 
driven to desperation by the cruel derision even of 
their nearest connections, and the mental anguish of a 
disease that must be felt to be imagined, in some of those 
horrid paroxysms, look to death alone for relief, and give 
way to the awful temptation of self-destruction. This 
should be a lesson to the friends of the hypochondriac 
and dyspeptic invalid. When from business or other cir- 
cumstances he is forced to quit the fire -side and take 
constant and continued exercise in the open air, or 
perform a journey of considerable length, he will often 
seem for a time to forget his ailments. He becomes 
cheerful and contented, enjoys the society of his family 
and friends, or participates in all the amusements and 
pleasures of social life. But after a very brief period of 
ease, and indulgence in the luxuries of the table- 
mark the change. At first perhaps his taste becomes 
faulty, or he has some slight uncomfortable sensations 
in the stomach or bowels ; then confusion of mind or 
intermission of the pulse, and finally, in rapid succes- 
sion, all his former horrible feelings and accumulated 
maladies. Now the cause of all this is an unhealthy 



DIGESTIVE ORGAJNS. 45 

condition of the bile and other secretions poured into 
the bowels and a high degree of irritability or morbid 
sensibility of their inner coats. But how can this be ? 
Perhaps nothing materially wrong is felt in the bowels 
and all the complaints are in the most distant parts of 
the body. Do we always feel uneasiness in the sto- 
mach when its derangement occasions headach? or 
does the child feel any thing wrong in the bowels 
when worms occasion convulsions ? Who has not passed 
a restless uncomfortable night after eating too freely of 
nuts, cheese, and many other indigestible substances, 
without feeling any thing wrong in the real seat of the 
irritation ? The fact is, the connection between the 
digestive organs and brain is one of the most curious 
in nature. They are not subject to the will, and yet 
they are influenced by the emotions of the mind. 

Who has not suddenly lost an excellent appetite on 
hearing some very unpleasant or painful news ? This 
fact did not escape the notice of the prince of English 
poets, for he makes Harry VIII. say to Wolsey on giv- 
ing him the papers, " Read o'er this — and after, this — 
and then to breakfast with what appetite you have." 

As has been before stated, when in perfect health 
we satisfy our appetite with a reasonable quantity of 
plain food, we feel nothing of it after it has been swal- 
lowed. But during digestion we feel a peculiar plea- 
surable sensation diffused over the whole system, 
without being able to refer it in particular to the diges- 
tive organs. The mind is cheerful and contented, and 
the body is refreshed and invigorated. So the same 
organs in a deranged state are capable of diffusing 
5 



46 DERANGEMENT OF THE 

through the whole system the most unpleasant sensa* 
tions, and exercising the most powerful influence over 
the passions and emotions of the mind without our be- 
ing at all conscious of the real cause. This should 
lead persons who are subject to occasional depression 
of spirits, or fits of irascibility and ill-humour, to sus- 
pect some fault in their digestion, and nineteen times 
in twenty the suspicion will be well grounded. 

Almost every part of the body may sympathise with 
the digestive organs. Thus certain persons feel at 
times a stiffness and pain in the motions of the eye ; 
but they do not infer from it that there is disease of 
that organ. Experience has taught them that they 
feel it when they are bilious, and that it vanishes after 
taking a cathartic. This then is a single instance of 
what is termed sympathy. In like manner, there may 
be pain, heat, and confusion of head, pains in the chest 
and cough, palpitations of the heart, intermissions of 
the pulse, difficulty in voiding urine, painful sensations 
in the limbs, and in fact in every part of the body, 
and all from sympathy with the alimentary canal. 

It has already been stated, that the bile is sometimes 
so acrid as to blister the skin when applied to it. From 
this fact some idea may be formed of its effects upon 
the delicate lining of the bowels ; for though they 
are embued with mucus to sheath and protect them, the 
constant presence of this acrid bile irritates them more 
or less, the effect of which will be a secretion of a 
thin mucus, not as well calculated to do its office, and 
at last the inner surface of the intestines must become 
exquisitely tender and sensible, and yet this highly 
offending matter very often passes through the bowels 



DIGESTIVE ORGANS. 47 

without producing any pain in them, though the brain 
or some other organ is made to suffer that torture 
which we cannot feel in its true seat, unless it excites 
those severe spasms called colic, when the muscular 
coat is affected, which is endowed with a different kind 
of sensibility. As has been explained, it is the inner 
coat that has no distinct feeling : indeed it has been 
often cut and torn when in a healthy state, in experi- 
ments on living animals, without apparently giving 
them pain. But when a diarrhoea is occasioned by 
the accumulated bile, which is then discharged in 
great quantities, it often gives rise to intolerable smart- 
ing and pain at the extremity of the bowels and wher* 
ever it touches the skin. Persons afflicted with 
the piles suffer excruciating torture from these dis- 
charges. If for a time the invalid lives on very sim- 
ple light food, and keeps his bowels open with some 
gentle medicine, the biliary and other secretions will 
be improved and his complaints alleviated. But let 
him indulge freely again in rich high-seasoned dishes 
and wine, and all his old maladies will return upon 
him with unabated violence, and after almost driving 
him distracted, will perhaps end for a time with a co- 
pious discharge of thick tenacious unhealthy bile, which 
acts upon him like poison. A paroxysm of this sort 
is described by Dr. Johnson, in his work on morbid 
sensibility of the stomach and bowels, with such gra- 
phic excellence and vividness of colouring, that I can- 
not deny myself the pleasure of transcribing it. 

" It is this tenacious ropy bile which hangs so long 
in the bowels of some people, and by keeping up a 
constant irritation of the intestinal nerves, produces a 



48 DERANGEMENT OF THE 

host of uneasy sensations in various parts of the body,, 
as well as fits of irritability in the mind. In some 
cases where this poisonous secretion lurks long in the 
upper bowels, whose nerves are so numerous and sym- 
pathies so extensive, there is induced a state of men- 
tal despondency and perturbation which it is impossi- 
ble to describe., and which no one can form a just idea 
of but he who has felt it in person. The term ' Blue 
Devils/ is not half expressive enough of this state, 
and if my excellent friend, Dr. Marshall Hall* meant 
to describe it under the head 6 mimosis inquieta,' he 
never experienced it in propria persona. This poison 
acts in different ways in different individuals. In some 
whose nervous systems are not very susceptible, it 
produces a violent fit of what is called bilious colic, 
with excruciating pains and spasms in the stomach 
and bowels, generally with vomiting or purging, and 
often succeeded by a yellow suffusion in the eyes, or 
even on the skin. Severe as this paroxysm is, the pa- 
tient may thank his stars that the poison vented its fury 
on the body instead of the mind. When the intellec- 
tual faculties have been much harassed and the ner- 
vous system weakened, the morbid secretion acts in 
that direction, and little or no inconvenience is felt in 
the real seat of the enemy. The mind becomes sud- 
denly overcast as it were with a cloud ; some dreadful 
imaginary evil seems impending, or some real evil of 
trifling importance in itself, is quickly magnified into 
a terrific form, attended apparently with a train of 
disastrous consequences from which the mental eye 
turns in dismay. The sufferer cannot keep in one po- 
sition, but paces the room in agitation, giving vent to 



DIGESTIVE ORGANS. 49 

his fears in doleful soliloquies, or pouring forth his ap- 
prehensions in ihe ears of his friends. If he is from 
home when this fit comes on, he hastens back, but soon 
sets out again in the vain hope of running from his 
own wretched feelings. If he happens to labour un- 
der any chronic complaint at the time, it is immedi- 
ately converted into an incurable disease, and the dis- 
tresses of a ruined and orphaned family rush upon his 
mind and heighten his agonies. He feels his pulse 
and finds it intermitting ; disease of the heart is threat- 
ened and the doctor is summoned. If he ventures to 
go to bed and falls into a slumber, he awakes in the 
midst of a frightful dream, and dares not again lay his 
head on the pillow. This state of misery may conti- 
nue for twenty-four, thirty-six, or forty-eight hours, 
when a discharge of viscid acrid bile in a motion of 
horrible fetor, dissolves at once the spell by which the 
strongest mind may be bowed down to the earth for a 
time through the agency of a poisonous secretion on 
the intestinal nerves. I believe such a train of symp- 
toms seldom obtains, except whe*re there has been a 
predisposition to morbid sensibility occasioned by men- 
tal anxiety, vicissitudes of fortune, disappointments in 
business, failure of speculations, domestic afflictions, 
or some of those thousand moral ills which render 
both body and mind so susceptible of disorder. It is 
under the influence of such paroxysms as these, I am 
thoroughly convinced, that nine-tenths of those melan- 
choly instances of suicide which shock the ears of the 
public take place. Nothing is more common than to 
hear of these catastrophes when no ostensible cause 
could be assigned for the dreadful act. There might 
5* 



50 DERANGEMENT OF THE 

be no real moral cause, but there was a real physical 
cause for the momentary hallucination of the judg- 
ment in the irritation of the organ of the mind, through 
sympathy with the organs of digestion. Such is the 
intimacy of connexion and reciprocity of dependence 
between the intellectual and corporeal functions." 

The peculiar appearance which the discharges pro- 
cured by cathartics often exhibit, has been noticed by 
several eminent writers. They are like a tenacious 
ropy jelly, compared by some to birdlime, and adhere 
so closely to the bottom of the vessel as to be removed 
with difficulty by water alone. An individual whose 
evacuations 1 have repeatedly seen of this descrip- 
tion, had suffered for years from a combination of the 
most distressing symptoms. The loins and urinary 
passages were the seat of constant severe pain, though 
there were never any indications of stone. The 
urine was in small quantity, turbid, and red, and could 
not be retained but for a few moments at a time, and 
gave excruciating agony in passing it. The whole 
attention of the invalid was directed to these organs, 
which were considered to be the seat of some fatal 
disease. 

During the worst paroxysms nothing was heard but 
the exclamations, I must die ! I must die ! It is im- 
possible to live in this condition. No one can conceive 
what I suffer, &c, and I regret to say, that these suf- 
ferings were occasionally aggravated by uncharitable 
friends, who believed them in a great measure imagi- 
nary. The appetite though variable, was not deci- 
dedly bad, and no inconvenience was felt apparently 
from light food ; but certain articles were evidently 



DIGESTIVE ORGANS. 51 

hurtful. The mind was in no way affected, except 
with the conviction that death was inevitable ; and the 
strength continued so little impaired as to render con- 
stant confinement to bed unnecessary. The bowels 
were never moved, except by cathartics, which were 
taken at intervals of a few days, and though their 
operation gave great pain, they relieved all the other 
symptoms when they procured the evacuations above 
described. Yet this person, after years spent in this 
way, enjoyed very good health, attained to a great age, 
and died at last of a local disease no way connected 
with the former complaints, proving that the urinary 
organs had been the seat of sympathetic derange- 
ment only. 

From the foregoing description it will be seen, that 
many of the symptoms of this species, particularly 
those which mark the deranged state of the liver, are 
common to the second. Indeed, there is no distin- 
guishing between the worst cases of the second and 
the milder cases of the third ; for the former may un- 
doubtedly pass into the latter, and the morbidly sensi- 
ble and irritable state of the lining membrane of the 
stomach and bowels, which is the principal character- 
istic of this species, be occasioned by the irritation of 
imperfectly digested food and vitiated bile. It must 
be remembered, that the division I have made into 
three species, is principally for convenience and the 
sake of distinction, as the majority of cases may be 
easily arranged under each of these heads, though all 
most certainly cannot. 



52 DERANGEMENT OF THE 



Causes. 



Whatever has a tendency to weaken any one or all 
of the digestive organs, either by acting directly upon 
them, or indirectly through the medium of other or- 
gans, or by weakening the system generally, may be 
considered as a cause of the foregoing disorders. 

It will at once be conceived, that the causes must 
be extremely numerous ; as the great inlet of nour- 
ishment for the body, the digestive organs, are liable 
to have their natural action disturbed by the quality 
and quantity of the prodigious variety of substances 
received into them. From their sympathy with every 
part of the body, they participate in all its diseases, 
and from their curious connexion with the reasoning 
faculties, they suffer in all the immoderate emotions of 
the mind. When we think how astonishingly all these 
are multiplied by civilization and refinement, and re- 
collect the-proneness to particular diseases which we 
inherit from our parents — (for unhealthy parents may 
transmit to a numerous progeny, if not their maladies, 
at least the peculiarity of constitution which rendered 
them liable to them) — it is more surprising that the 
digestive process is so regularly performed in the 
great mass of individuals, than that indigestion and its 
gloomy train should be so often met with as it is. 

The natural power or tone of the stomach will 
scarcely be found the same in any two persons, but 
varies as much as the physical power of the body. 
Thus we find that of two men of equal size, one can 
raise a weight of 600 pounds, the other of only 300 ; 
the stomach of one will dissolve almost any substance 



DIGESTIVE ORGANS. 53 

he chooses to swallow, the other dissolves with diffi- 
culty many of the ordinary articles of food. We see 
the physical strength of some men greatly increased 
by constant exercise ; so the stomach may be edu- 
cated, if I may so speak, to perform many of the 
astonishing operations of that of the ostrich. 

And here let me remind parents that this should be 
a useful hint respecting the manner of bringing up 
their children ; for taken in season, the human consti- 
tution admits of being moulded and fashioned by a 
skilful hand to a degree almost incredible. Thus the 
delicate and puny by suitable diet, air, and exercise, 
may be often rendered healthy and even robust, while 
the hardy offspring of the rugged labourer, by being 
fed on dainties and confined to a bad atmosphere, will 
be feeble and infirm. Those who have naturally weak 
stomachs may, by prudence and care, enjoy a tolera- 
ble measure of health, while those who have the 
strongest may be at last completely broken down 
by irregularity and excess, and if we now and then 
see persons apparently unaffected by a long course of 
every species of intemperance and dissipation, it only 
shows how long nature will allow herself to be out-, 
raged in some cases, without visiting the offender with, 
speedy vengeance, and is a strong proof that had they 
consulted reason and moderation, they might in, all 
probability have attained a great age in the rational 
enjoyment of all the comforts and allowable pleasures 
of life, and almost bid defiance to disease. To enu- 
merate all the causes of derangement of the digestive 
organs is quite unnecessary ; but I shall examine some 
of the most common under the heads of Physical and, 
Moral Causes. 



54 DERANGEMENT OF THE 

Physical Causes, 

Undoubtedly the most common of all the causes of 
derangement of the digestive organs, is eating too 
much. Few are contented with the small quantity of 
simple nourishment which nature actually requires, 
but almost all indulge, more or less, in the pleasures 
of the table ; and not unfrequently yield to the strong 
incentives of variety, high seasoning, stimulating 
drinks, &c. to prolong them to an immoderate extent. 
Those who will take the trouble of reading the early 
life of that distinguished philosopher, Dr. Franklin, 
may convince themselves, without going back to the 
diet of the Spartans, how very little plain food is suf- 
ficient to maintain the human body at the maximum of 
strength and activity. We may eat too much, either 
by indulging at a single repast or by eating too often* 
IVhen from the variety of dishes calculated to please 
the taste — the relish imparted by the presence of friends 
— the stimulus of generous wine, and the different 
heating condiments, we give up our reason for the gra- 
tification of the palate, and eat and drink beyond a 
certain point; the face becomes flushed — the pulse 
beats full and hard — the spirits are elevated — and we 
are disposed to be pleased with those around us, and 
indulge in what we term relaxation from business and 
care. But the pleasures of conviviality are short-lived. 
In a few hours, when the fumes of the wine and other 
stimulants have vanished a little, we become sensible 
that we have violated the plainest law of nature, and 
loaded the stomach with more food than it can conve. 
niently contain. Our clothes feel too tight, and we 



DIGESTIVE ORGANS. 55 

have an uncomfortable sense of fullness and distention. 
The heterogeneous mass in the stomach swells, from 
being subjected to an elevated temperature and the 
rarefaction and expansion of the fluids with which it 
is mixed. From the chemical changes which now 
take place, gas is disengaged in considerable quanti- 
ties, and gives rise to eructations. Heaviness and 
drowsiness succeed to the exhilaration of spirits, and 
the night is either spent in tossing from side to side, 
with thirst, fever, pain of the head, and throbbing of 
the temples ; or in unrefreshing sleep accompanied by 
snoring, and interrupted by frightful dreams and at- 
tacks of night-mare. In the morning the head is 
painful and hot — the tongue is furred — there is a dis- 
agreeable taste in the mouth, and a feeling of langour 
and listlessness that should teach us the criminal im- 
propriety of immoderate indulgence. The urine is 
high coloured — there are uneasy sensations in the 
bowels, and diarrhoea is often produced by the acid — 
half digested matters which have passed from the sto- 
mach into the bowels, exciting the liver to pour out an 
unusual quantity of bile, and constantly fermenting 
and forming new and irritating combinations. But it 
is quite as common an occurrence for people to take 
too much food by eating too often, and those who do so 
are not unfrequently unconscious of it, though they feel 
that all is not right within them. We often hear them 
wondering what can be the cause of their unpleasant 
sensations, when they would blush even at the thought 
of gluttony. When the stomach is over distended at 
a single meal, it is neither capable of duly contracting 
upon the mass, or of supplying the quantity of gastric 



56 DERANGEMENT OF THE 

juice required to dissolve it entirely, of course a part 
must ferment. But when one meal follows too soon 
upon another, before the first has been acted on and 
made room for the second, the regular digestive pro- 
cess must be more or less disturbed. Gastric juice is 
required before the stomach has recovered from the 
fatigue, if I may so speak, of disposing of the first 
meal, and the juice supplied will be weak and illy 
prepared to do its office with promptness. Conse- 
quently the second meal will not be properly digested, 
but give rise to exactly the same results as eating too 
much at once. This may be inferred from the follow- 
ing circumstances : a too quick succession of meals 
has a tendency to excite the appetite by the sight of 
palatable food when nourishment is not actually re- 
quired ; in the same way that the several courses at 
dinner will have a similar effect. A man could rise 
from table after the ordinary quantity of soup and fish, 
"not only satisfied, but saturated ;" and yet by a suc- 
cession of different dishes his appetite may be repeat- 
edly roused to demand more. 

"Thus then," says Dr. Paris, "it is, that the sto- 
mach is made to receive not one full meal, but a suc- 
cession of meals rapidly following each other and 
vying in their miscellaneous and pernicious nature 
with the ingredients of Macbeth's caldron." 

Again, we may reasonably conclude, that if the di- 
gestive process may be disturbed and a healthy chymi- 
fication of the food prevented in a weak stomach by 
eating too often, a too rapid succession of meals may 
have more or less of the same effect in a strong one. 
Dr. Philip says, " The dyspeptic should eat nothing in 



DIGESTIVE ORGANS. 57 

the intervals of these meals. There is no greater 
mistake than that he should be constantly taking some- 
thing. This disturbs the natural process and entirely 
prevents the recurrence of appetite, a certain degree 
of which is a wholesome stimulant to the stomach. 
The stomach by this constant eating, becoming more 
and more debilitated." Dr. Paris says, " the anxiety 
of friends, and the popular errors which exist upon 
the subject of diet, are apt to establish the mischievous 
belief that " a little and often" will be more likely to 
restore the languid stomach to its healthy tone, than 
moderate meals at more protracted intervals ;" and 
again, he says, " the natural process of digestion is 
thus disturbed, and the healthy action of the stomach 
as evinced by the return of moderate appetite, is en- 
tirely prevented." It should be recollected that by 
appetite in both these quotations, is meant the actual 
demand of the system for nourishment, and not the 
desire excited by a savory dish; for this last will 
sometimes exist when the stomach can literally hold 
no more. 

In most persons, some little time is required after 
one meal has been digested for the stomach to resume 
its tone, which is indicated by the renewed desire for 
food; amounting to hunger if the fast is sufficiently 
long ; but in children, whose systems require a great- 
er quantity of nourishment than adults, and in a few 
who have arrived at maturity, this does not appear to 
be the case ; as they can eat almost constantly : at all 
events, the energy of the stomach is so great, that it 
seems to need no intermission of action, but is ready 
6 



58 DERANGEMENT OF THE 

for a fresh supply the moment it is empty, and even if 
not, will readily master all that is sent to it. 

Those who take much exercise require more food 
to supply the waste of the system, than those who do 
not; but if an active life is changed for one of ease, 
and the same habits of eating and drinking continued, 
indigestion is almost invariably the consequence. 

Persons in easy circumstances, are often so uncon- 
scious of the quantity they eat and drink, that if they 
were to throw into a vessel as much of every thing as 
they take themselves, the collection at the end of 
twenty-four hours, would astonish them. An anecdote 
which was related to me by a gentleman who had been 
a pupil of the celebrated Dr. Gregory, has consider- 
able bearing on this subject.* 

A wealthy manufacturer from the west of Scotland, 
while at Edinburgh on business, called on Dr. G. 
for his advice. He was a man of middle stature, 
rather corpulent, with a rosy complexion, and whose 
exterior altogether bespoke the comfortable liver. 
After seating himself, the following dialogue ensued. 

Gentleman. Well, Dr. Gregory, I ha' come up to 
Edinbro' i' the way o' business, and I just thought I 
would take your advice about my health. 

Doctor. Your health, sir ? what is the matter of 
you? 

Gent. I'm no just sae weel i' the stomach as I'd 
like to be. 

Dr. The stomach ! I suppose you are a drunkard 
or a glutton then, sir. 

* I give this entirely from memory. 



DIGESTIVE ORGANS. 59 

Gent, Na, na, Dr. Gregory, ye carina say^ that — 
ye canna say that — ye maun ken that Fm a sober man, 
and a temperate man, and a deacon o' the kirk as my 
worthy father was afore me. 

Dr. Well, let us see, what do you eat and drink ? 
What do you take for your breakfast ? 

Gent. I take coffee or tea wi' toast, and a fresh 
egg or a bit o' salmon ; though I ha' no much appetite 
for my breakfast. 

Dr. Yes : and then you take something by way 
of lunch, between breakfast and dinner 1 

Gent. I canna say I care ower much about the 
lunch, but I can take a bit o' bread and cheese wi' a 
glass o' ale, if it be there ; but I canna say I care 
ower much about it. 

Dr. Well, what do you eat for dinner ? 
Gent. Oh ! I'm no very particular, though I maun 
say I like my dinner . 

Dr. I suppose you take soup first ? 
Gent Yes : I can say I like my soup. 
Dr. And a glass of porter, or brandy and water 
with it? 

Gent. Yes : I like a glass o' something wi' my 
soup. 

Dr. And then you have fish, or beef, or mutton, 
with vegetables ? 
Gent. Yes. 

Dr. And a glass of ale or porter with them ? 
Gent. Yes : I take a glass o' ale now and then 
wi' my meat. 

Dr. And then you have boiled fowl and bacon, 
or something of that sort, I suppose ? 



60 DERANGEMENT OF THE 

Gent. Yes : I maun say I like a bit o' fowl and 
bacon now and then. 

Dr. And a glass of something with them ? 

Gent. Yes. 

Dr. And after the fowl you have pudding ? 

Gent. I'm no sa' fond o' the pudding, but I can 
take a bit o't if it be there. 

Dr. And you must drink wine with your pud- 
ding? 

Gent. I canna take ower much o' the wine, but 
if I ha' a friend wi' me, I maun take a glass or so. 

Dr. And then you have cheese or nuts ? 

Gent. Yes : the gude wife is ower fond o* them, 
but I canna say I care much about them. 

Dr. But you take a glass or two of wine with 
your nuts ? 

Gent. Yes : a glass or two. 

Dr. Well, you do not finish your dinner without 
whiskey-punch ? 

Gent. I find my dinner sits better on my stomach 
with a little punch, so I take a glass or so. 

Dr. And you have tea I suppose ? 

Gent. Yes : I maun take my tea with the gude 
wife. 

Dr. And a bit of something with it ? 

Gent. Yes : I can take a bit o' something if it be 
there. 

Dr. But you do not go to bed without supper ? 

Gent . Na, na, Dr. Gregory, I canna say I like to 
gang to bed without my wee bit supper. 

Dr And what do you eat for supper ? 



DIGESTIVE ORGANS. 61 

Gent. Oh ! a bit o' ony little thing — a bit o' sal- 
mon or boiled tongue, or cold fowl. 

Dr. And a glass of something with it ? 

Gent. Yes. 

Dr. And can you go to bed without a night cap 
of hot punch ? 

Gent. I maun say I sleep the better for a glass o' 
hot whiskey punch — though I canna say I'm ower 
fond o 7 the habit. 

Dr. Well sir, you are a fine fellow ; you are 
indeed a fine fellow : you come to me w 7 ith a lie in 
your mouth, and tell me you are a sober man, and a 
temperate man, and a deacon of the kirk as your wor- 
thy father was before you : and you make yourself out 
by your own statement, to be a glutton, and a wine bib- 
ber, and a whiskey tippler,y,nd a beer swiller. and a 
drinker of that most abominable of all compositions 
called punch. Go home, sir, and reform yourself, 
and become temperate in your eating and drinking, 
and you will have no need of my advice. 

It has been stated, that indigestion is exceedingly 
prevalent in this country. Considerable observation 
induces me to believe that it is far more so than in any 
other, not even excepting England ; where it probably 
exists to a greater extent than in any other part of 
Europe ; and where it is strongly suspected by some, 
of being extensively propagated by the vast numbers 
who return dyspeptic from tropical countries, and 
entail to their offspring a predisposition to it. One 
reason why I believe it to be more common here than 
in England, is, that it may be said to be confined to 
the classes in easy circumstances among the English ; 
6* 



62 DERANGEMENT OF THE 

while the labouring classes, particularly the agricul- 
tural, are comparatively exempt from it, though it 
exists among them from intemperate drinking. With 
us, it is not only as prevalent among those in easy cir- 
cumstances as in England, and I have no doubt much 
more so — but is met with at every step, (especially 
among the females) even in the humblest walks of 
life. This undoubtedly arises from the fact, that ow- 
ing to the very great cheapness of all kinds of food, 
the poor feed sumptuously in America when compared 
to those of England ; and the females, instead of as- 
sisting their husbands in the field, and engaging in a 
great variety of occupations in the open air, so com- 
mon in England, confine themselves almost entirely to 
the house, and are consequently much less strong and 
healthy. 

This great prevalence of indigestion among us, may 
be attributed to a variety of causes, some of which 
are peculiar to us as a people. In the first place, our 
climate is much Jess favourable to strong stomachs 
than that of England. During the summer we are 
exposed to a much higher, and during the winter to a 
much lower temperature than the English. The tran- 
sition from one extreme to the other has such an evi- 
dent effect upon the constitution, as to be noticed by 
the most unobserving. In the spring, the tone of the 
digestive organs is perceptibly diminished by the ap- 
proaches of hot weather, as marked by a disrelish for 
animal food ; and the great susceptibility to those 
derangements termed foul stomach, bilious attacks, 
jaundice, &c. With the continuance of hot weather, 
the tone of these organs is not only diminished, but 



DIGESTIVE ORGANS. 63 

they acquire a high degree of irritability, hence the 
prevalence of cholera morbus, dysentery, and diar- 
rhoea. Of these three diseases, less than one hundred 
cases are reported in the bills of mortality for London, 
containing between a million and a million and a half 
of inhabitants, in ten years ending in 1824. While in 
New-York, with a population of about two hundred 
thousand, two thousand cases are reported in ten years 
ending in 1829. 

As the cold weather returns, the appetite for animal 
food increases, and the winter removes, in a great mea- 
sure, the irritability and weakness of the digestive or- 
gans. It must be evident, that if aside from climate 
we are exposed to the same causes of dyspepsia as 
the English, the effects of our climate must give 
greater force to those causes, and throw the odds fear- 
fully against us in escaping their operation. It may 
be asked if our summers are so debilitating to the 
digestive organs, why are not the inhabitants of the 
South of France, Italy, Spain, &c. as liable to dys- 
pepsia as we are ? I answer, our cold winters and 
the far greater quantity of animal food we then con- 
sume, place our constitutions upon the scale of the 
inhabitants of northern climates, and we suffer to a 
certain extent by the transition from winter to sum- 
mer as they do by a removal to the tropics. The 
difference is, they soon become acclimated, as it is 
termed, while we are constantly passing from one ex- 
treme to the other. 

It may be said that the climate of England is alto- 
gether more variable than our own. I admit it : no- 
thing is more common than to have all the varieties of 
weather that characterise the four seasons, within the 



64 DERANGEMENT OF THE 

twenty-four hours ; but what is all this when compared 
to the astonishing number of degrees through which 
the mercury ranges in America, from the coldest day 
in winter to the hottest day in summer ? In many 
places in the northern states, the mercury frequently 
sinks from 15 to 25 degrees below zero in winter, and 
rises to 96 in summer. In New-York, it is not a re- 
markable occurrence for the mercury to sink below 
zero in winter, and to rise to 90 and even to 96 in 
summer — a difference of nearly a hundred degrees. 
In London, from the commencement of 1812 to the end 
of 1824, (thirteen years) the mercury never sunk but 
twice below 10 deg. and rose but twice above 86 ; the 
highest average was 83, and the lowest 15, making 
the mean difference between summer and winter 68. 

Mode of Living. 

Not only Americans who have been abroad, but all 
foreigners who have been among us, agree in this ; 
that in no country is the table loaded with such pro- 
fusion as in ours. I speak not of the sumptuous en- 
tertainments of the rich, but of the every-day meal 
of all classes from the labourer to the most opulent. 
Take for example, the country farmer, who works 
his own land. In the morning he sits down to a 
breakfast of tea or coffee, bread and butter, eggs, 
ham or a steak, or cutlette of some sort, potatoes, 
<Scc. His ordinary dinner is boiled beef and pork, 
with almost every variety of vegetables, and cider 
or beer. This is usually about 12 or 1 o'clock ; 
and at evening he has his tea, bread and butter, dried 
beef or cold meat, and now and then cakes and pies, 
sweetmeats, &c. This is his common fare ; but if he 



DIGESTIVE ORGANS. 65 

happens to have a friend to visit him, his table groans 
under the load of every thing in the way of good eat- 
ing and drinking our country affords. Now compare 
this with the living of the French farmer of the same 
grade. His breakfast is a roll of bread, a cluster of 
grapes or an apple, and some thin weak wine, not as 
strong as our cider. His dinner consists of bread and 
vegetables in the form of soup or potage ; if he eats 
meat at all, it is literally cooked to rags, and his this 
wine. Instead of our tea he has a roll of bread and 
a glass of wine again. In England it is far more sub- 
stantial ; but with little variety. Tea, oatmeal and milk r 
or bread and cheese, and malt liquor for breakfast ; 
meat, bread, and vegetables with malt liquor for dins, 
ner; and bread and cheese with the aforesaid beve- 
rage for supper. But while the poor day-labourer m 
France and England is compelled to subsist almost 
entirely on bread and potatoes, with us he eats animal 
food three times a day, with abundance of bread, ve- 
getables, and even butter and cheese. In the country 
they will not, to use their own expression, " do a stroke 
of work" without as much as they can eat and drink, 
and that commonly at the expense of the employer* 

Our first boarding-houses may be taken as a specimen 
of the manner of living of a considerable portion of the 
community in our large towns. The breakfast is usu. 
ally at eight, and consists of tea, coffee, bread and 
butter, potatoes, eggs, broiled fish, beef-steaks, mut- 
ton chops, and hot cakes or fresh rolls. At eleven* 
soup, cold meat and tongue is served up, and at 
three, a dinner of fish, flesh, and fowl — roast, boiled, 
and broiled of all sorts — with every vegetable common 



66 DERANGEMENT OF THE 

to our olimate, followed by puddings, pies, and fruits, 
with cider, beer, or brandy and water as ordinary 
drink; and these things are not served out with a 
sparing hand, but in quantities that strike the Euro- 
pean as extravagant and wasteful. Tea is prepared 
at six or seven, accompanied by toast, bread and but- 
ter, cakes, &c, and not unfrequently something in the 
shape of supper makes its appearance about bed time. 
Now the most remarkable peculiarity in all our meals 
is what may be emphatically called an American 
breakfast — a meal no way inferior in quality and 
quantity to a European dinner ; and one, I am tho- 
roughly convinced, that occasions more weak stomachs 
than can possibly be imagined by those who have not 
paid particular attention to this subject. To the la- 
bouring man who rises at four o'clock, such a break- 
fast at eight may not be injurious ; but persons not in 
active business, females, and especially those of both 
sexes who do not rise before seven, a repast of this 
kind at eight cannot, with few exceptions, be long made 
with impunity. 

When we first rise in the morning the system is re- 
stored to its full vigour, and may be compared to a 
clock that is just wound up, and we have no need of 
nourishment till the energy accumulated by repose is 
partially wasted by exercise. We feel no desire for 
food, of course the stomach is not prepared for diges- 
tion ; for in order to secrete a healthy gastric juice 
and perform its functions promptly, it must acquire a 
certain degree of tone by fasting, which is indicated 
by appetite. Now if food is taken before the stomach 
is thus prepared for it, or in other words, when we 



DIGESTIVE ORGANS. QJ 

have no appetite, it acts tardily ; of course the solu- 
tion of the food is apt to be more or less imperfect, 
and a constant repetition of the same thing will at last 
weaken its powers. Those who are blessed with a 
strong stomach may for a time at least, experience no 
inconvenience from a hearty breakfast the moment 
they are out of bed, but it is far otherwise with him 
who has a weak one. He feels oppressed and incom- 
moded by his food very soon after rising from table. 
He puts his hand to his forehead and finds it hot, and 
immediately complains of pain and heaviness ; many 
of the symptoms already described appear in succes- 
sion, and after an uncomfortable morning he has but a 
poor appetite for his dinner. Ten to on°e he does not 
suspect the real cause of his unpleasant feelings, but 
fancies he has « a foul stomach," or is something bi- 
lious, and is much more easily induced to swallow 
whole boxes of pills than to make any alteration in 
the quality of his breakfast. 

As I before remarked, the labouring man who first 
spends three or four hours in active employment, may 
go to an American breakfast without danger ; but not 
so the comparatively inactive. In this respect I look 
upon our fashionable boarding-houses as a fruitful 
source of indigestion. How often do we see persons, 
there of both sexes, coming directly from their bed- 
chamber to the breakfast table, and stimulated by the 
example of others and the savory dishes before them, 
eating heartily of steaks, cutlettes, ham and eggs, &c! 
without the least real appetite. But the evil does not 
exist in our boarding-houses alone : who has not seen 
in the most respectable families, a pale-faced girl of 



68 DERANGEMENT OF THE 

sixteen or eighteen swallow as much beef-steak in half 
an hour after appearing in the morning as would an- 
swer for her dinner ? Or if she shows any disinclina- 
tion to a small bit at least, she is immediately address- 
ed by a fond parent with, My dear, you don't eat any 
thing ; I am afraid you are ill. Do try to take some- 
thing, and a thousand other affectionate inducements 
to eat what is not required. I know there are many 
well informed persons who, aware of the bad effects of 
meat-breakfasts, content themselves with eggs, bread 
and butter, toast, &c. but they constitute a very small 
part of our population, and even they are generally 
unconscious of the vast difference as it respects health 
between eating the moment they are out of bed, and 
waiting till they have an appetite. 

If eating without an appetite is injurious, going too 
long without food is apt to be equally so, by inducing us 
almost always to eat far too much. Thus the merchant 
hurries down his early breakfast and then goes to the 
counting-house, where he not unfrequently remains 
till a late hour in the afternoon, without tasting any 
thing. In this way his appetite becomes very keen, 
and in order to satisfy it he swallows his dinner almost 
without chewing, eats much more than he requires be- 
fore he feels that he has enough, and then takes wine 
or brandy to relieve the uncomfortable sensation of 
fulness which supervenes, and having finished the 
business and fatigues of the day, gives himself up to 
his nap or lounge on the sofa. The consequence is, 
by the time his fortune should be made, he has laid the 
foundation of a train of distressing complaints, de- 
pending upon indigestion, which destroy all the long 



DIGESTIVE ORGANS. 69 

promised pleasures of ease and retirement, embitter 
his days, and give employment to the doctor and apo- 
thecary. 

But I cannot leave this subject without urging upon 
my readers the immense importance of observing the 
simple rule, never to eat without an appetite. Let 
them mark the difference in their feelings when they 
have taken a walk or drive fasting, which has not only 
given a high relish for breakfast, but has so quickened 
the action of the stomach that they have eaten more 
and digested it better than they ordinarily do. On the 
other hand, if the stomach is oppressed with food be- 
fore it demands it, nothing like a healthy appetite is 
acquired for dinner, though the acrid remains of the 
imperfectly digested breakfast, together with the habit 
of eating at certain hours, occasion an uneasy sensa- 
tion which is often mistaken for real hunger. If a sub- 
stantial dinner is now taken, the stomach is slow in 
performing its office, and is the seat of uncomfortable 
feelings, weight, and fulness. To relieve these and 
rouse the oppressed organ to greater exertions, stimu- 
lants such as wine and brandy are resorted to, and 
they will have the effect for a time ; but it is much 
like loading a feeble horse beyond his strength, and 
then applying the whip and spur to quicken his move- 
ments. And as certain as it is that the horse will sink 
the sooner for being flogged to perform impossibilities, 
so certain it is that these stimulants will at last give 
the finishing stroke to what little power the stomach 
may still possess. 

All our most eminent physicians agree in this one 
point, that as a people we eat far too much hearty 
7 



70 DERANGEMENT OF THE 

food ; that is, we take in more rich nutriment than we 
require, and the consequence is, our system becomes 
overloaded and oppressed, our organs are clogged in 
the performance of their several functions, the circu- 
lating fluids become too thick and stimulating, and the 
proneness to derangements and diseased action greatly 
increased. Hence arises a large proportion of the 
inflammatory and febrile diseases amongst us, and 
hence it is that copious blood-letting and active medi- 
cines are so much more required in America than in 
most other countries — a fact admitted by all those 
physicians whose opportunities of observation have 
enabled them to form a correct opinion on the subject. 
It is a popular notion among us that a considerable 
allowance of animal food is absolutely necessary to 
perfect health and strength ; for this reason all eat it 
once, many twice, and some three and even four times 
in the twenty-four hours. Now nothing is easier than 
to prove this a mistaken idea, by referring to nations 
who have firmer constitutions than ourselves, and who 
inhabit both colder and warmer countries than our 
own. " We would beg leave to state," says the Jour- 
nal of Health, a work that promises to be exceedingly 
useful, " that the large majority of mankind do not 
eat any animal food, or so sparingly and at such long 
intervals, that it cannot be said to form their nourish- 
ment. Millions in Asia are sustained by rice alone, 
with perhaps a little vegetable oil for seasoning. In 
Italy and Southern Europe generally, bread made of 
the flour of wheat or Indian corn with lettuce and the 
like mixed with oil, constitutes the food of the most 
robust part of its population. The Lazzaroni of Na- 



DIGESTIVE ORGANS. 71 

pies, with forms so active and finely proportioned, 
cannot even calculate on this much ; coarse bread and 
potatoes are their chief reliance ; their drink of luxury 
is a glass of ice-water slightly acidulated. Hundreds 
of thousands, we might say millions of Irish do not 
see flesh meat or fish from one week's end to the 
other. Potatoes and oatmeal are their articles of food. 
If milk can be added, it is thought a luxury. Yet 
where shall we find a more healthy, robust population, 
or one more enduring of bodily fatigue, and exhibit- 
ing more mental vivacity ? What a contrast between 
these people and the inhabitants of the extreme north 
— the timid Laplanders, Esquimaux, Samoideans, — 
whose food is almost entirely animal." 

If we were to judge of the effects of an animal or 
vegetable diet by the health and longevity of those 
who have uniformly adopted either, we should not 
think most favourably of the animal diet. Indeed, it 
is an uncommon thing for great meat eaters ever to 
attain old age, while it is recorded of all those, so far 
as I am acquainted, who have arrived at or passed one 
hundred years, that they invariably used animal food 
very sparingly if at all, and most of them so seldom 
that it could not be considered a part of their diet ; 
but subsisted entirely on bread, vegetables, and milk. 

Another popular notion is, that feeble delicate per- 
sons require very nourishing food, such as beef, rich 
soups, jellies, &c. in order to give them strength — 
than which there cannot be a greater error. Their 
system may be compared to that of the infant which 
requires only the lightest and simplest food, possess- 
ing a great share of irritability, (which is generally 



72 DERANGEMENT OF THE 

connected with weakness,) and easily excited to un- 
healthy action by any undue stimulus. But nothing 
will be more difficult than to convince such persons 
that they do not need at least a little animal food, or 
to persuade them to adopt the simple diet most suita- 
ble for them. They will often admit that wine and 
porter disagree with them, because their effects are so 
immediate that they cannot mistake them ; but they 
cannot understand how rich food can have exactly the 
same effect, to a certain extent, as wine and porter ; 
and that if the one is hurtful, the other must be. 

It is almost impossible to convince a person that the 
thing he is most fond of is hurtful to him ; but when 
he is once satisfied that it is so, there is generally but 
little trouble in inducing him to renounce it. He feels 
himself weak — he infers from this that he has need of 
very nutritious food, and his friends, unconscious of 
the fact that it is not the quantity eaten, but the quan- 
tity digested, that nourishes the system, and that all 
that is eaten and not digested overloads and oppresses 
it, tell him if he does not eat hearty things he will not 
recover his strength. He makes the trial, but the 
more he eats the weaker he grows, because he over- 
loads his system. Medicine is then resorted to, which 
unloads the machine and re-establishes its natural 
movements. Now, instead of hearty food let him try 
that which is very light and digestible, and he will 
soon come to the conclusion that it is altogether the 
most strengthening. 

It is very desirable that people, as it respects them- 
selves, should be undeceived on the subject of animal 
food, though it would be directly against the pecuniary 



DIGESTIVE ORGANS. 73 

interest of the medical profession ; for it will be rea- 
dily admitted by every intelligent physician, that an 
immense proportion of his business arises from the 
effects of too hearty food. What occasions two-thirds 
of all the inflammatory and febrile diseases? but 
causes in themselves not serious, operating upon a 
system highly susceptible of diseased action from be- 
ing overcharged with stimulating and nutritious mat- 
ter. All agree that the animal machine requires to be 
sustained with nourishment, in proportion to the wear 
and tear to which it is exposed ; of course, that the 
hard labourer demands altogether more than the idle 
and inactive. According to this rule, if the hard la- 
bourer eats meat twice a day, his employer, who only 
walks about and inspects his business, can need but a 
very small quantity once a day ; while his wife and 
daughters, who only go out occasionally, and his pro- 
fessional son, who spends much time over his books, 
should never taste any thing heartier than milk, bread, 
and vegetables. But those in easy circumstances 
cannot conceive how meat should be bad for them, 
when they have eaten it from their infancy ; neither 
will the confirmed dram-drinker be convinced that he 
is daily swallowing poison, till it produces its gradual 
but certainly fatal effect. " In our climate," says 
Dr. Paris, " a diet of animal food cannot, with safety, 
be exclusively employed. It is too highly stimulant ; 
the springs of life are urged on too fast, and disease 
necessarily follows." — If this can be said of England, 
what must be inferred of America, whose summers 
more resemble those of the West-Indies than of Eng- 
land? 



74 DERANGEMENT OF THE 

Eating too fast may be set down as one of our na* 
tional peculiarities, as every foreigner on first coming 
among us is forcibly struck with the rapid manner in 
which we devour our food. If he dines at an hotel 
or on board of one of our steamboats, he sees the 
courses of meats vanish, before he has finished his 
soup, and if he promises himself a comfortable half- 
hour over his dessert, he finds himself left alone and in 
the way of the servants. This canine mode of feed- 
ing is more common perhaps in some sections of the 
union than in others, but prevails generally, I believe, 
to a greater or less degree at all our public tables ; 
though I am not disposed to admit that the latitude of a 
place may be ascertained with tolerable accuracy, by 
the number of minutes the inhabitants spend at their 
dinner, as has been stated by a late traveller. At the 
private repast the same habit exists, also, to a very 
great extent, and I am thoroughly convinced, that no 
one apparently innocent habit is attended with more 
really pernicious consequences. The food is swal- 
lowed whole or nearly so, instead of being minutely 
divided by mastication and mixed with a suitable quan- 
tity of saliva, so necessary as we have already seen 
to healthy digestion. A greater quantity is taken than 
is required before the appetite subsides, for in fact, 
we overload the stomach before it has time to indicate 
that it has received enough. It is in this way many 
persons eat too much who would be shocked at the 
charge of gluttony ; for if they eat more than they can 
easily digest, though not one quarter as much as is 
eaten by others, it is overeating in every sense of the 
word. The stomach is distended with a mass of solid 



DIGESTIVE ORGANS. 75 

matters which soon begin to swell, distending it still 
more, by its bulk preventing its proper contractions, 
and by its solidity almost bidding defiance to the 
strongest gastric juice, and not unfrequently portions 
of meat, cheese, vegetables, fruits, &c. pass through 
the stomach and bowels and are at last discharged in 
a state so entire and unchanged as to be easily recog- 
nisable. Can any reasonable being suppose that na- 
ture will be thus outraged with impunity ? No ! rest 
assured. Though slow to take vengeance, it will ne- 
vertheless certainly come at last, and she will make 
her victim feel the full force of that lash whose keen 
tortures are only known to the dyspeptic and hypo- 
chondriacal invalid. The mischievous effects of fast 
eating are far from being confined to those who do so 
habitually. Those who would take time to thoroughly 
masticate their food, gradually fall into the same error 
from the force of example, or hurry through their 
meals for fear of appearing singular. 

Spirituous Liquors. 

The immoderate use of distilled liquors is a cause 
of indigestion, about which so much has been lately 
written and said, that it might seem almost superfluous 
to comment largely upon it here — but that it is a prac- 
tice so pregnant with evil, so destructive of life and 
human happiness, that the warning voice of those who 
are competent to estimate all its horrid consequences, 
should never be silent against it. In all civilized 
countries, this evil exists to a greater or less degree ; 
but in our own, the cheap rate at which distilled liquors 



76 DERANGEMENT OF THE 

can be obtained, has rendered the habitual use of them, 
especially among the labouring classes, more general 
than in almost any other. Even in the higher orders 
of society, their desolating effects are but too visible ; 
though the popular current now begins to set strongly 
against them, and if the man of respectability is com- 
paratively less often seen debasing that intellectual part 
which alone gives him a resemblance to his Maker, and 
deliberately sinking himself below the brute creation, 
the innumerable cases of dropsy, dyspepsia, liver 
complaint, apoplexy, palsy, and a host of other ma- 
ladies, which can with certainty be referred to the ne- 
farious products of distillation, and daily demand the 
physician's aid ; bear evidence alas, but too conclusive, 
that no rank or station has been beyond the reach of 
their deadly influence. The effects of spirituous drinks 
upon the digestive organs, are the following : taken 
with the food or soon after it, they rouse the stomach 
to act upon its contents with greater vigour, and the 
liver to pour out more bile than ordinary. This ac- 
counts for the relief given by a glass of brandy to the 
unpleasant sensations sometimes experienced after 
eating fresh pork, roasted goose, &c. Hence persons 
with rather weak digestion, often get in the habit of 
constantly taking spirits with their meals. It is unne- 
cessary to say the stimulus is unnatural. The sto- 
mach at last becomes tired of being thus goaded on 
to extra efforts, or in other words, becomes insensible 
to its effects and sinks into a torpid state, constituting 
one of the worst forms of dyspepsia. The same thing 
takes place in the liver : instead of pouring out bile in 
abundance, as at first, its functions become greatly de- 



DIGESTIVE ORGANS. 77 

ranged; it is the seat of chronic inflammation; its 
healthy structure is destroyed ; and often great en- 
largement takes place, occasioning dropsies and a 
variety of other diseases. When dilute alcohol is 
taken upon an empty stomach, (as appears from late 
experiments,) it excites its vessels to pour out a great 
quantity of mucus, which, uniting with the alcohol, 
decomposes it in part, and acid is generated. This 
last passing into the bowels, irritates their nerves, and 
occasions a considerable flow of bile from the liver* 
In many persons, two or three glasses of wine taken 
on an empty stomach before going to bed, will excite 
the liver to pour out so much bile that it regurgitates 
into the stomach, producing pain in the head, giddiness, 
bitter taste in the mouth, nausea, and even vomiting of 
clear bile on first rising the following morning. This 
effect seems more immediately injurious to the consti- 
tion than when spirits are taken with the food ; for we 
see the man who tipples at all hours soon breaking 
down with disease, while he who drinks hard with his 
dinner, may hold out for a longer time, though he 
shares the same fate at last. 

Want of fresh air. 

Among our females of respectability, confinement 
to warm apartments in winter, and want of exercise 
at all seasons, may be set down as a common cause of 
indigestion. This sort of in-door existence, may un- 
fortunately be said to be almost a national character- 
istic of our married ladies. How many thousands of 
them never leave the house except on Sunday, or 



78 DERANGEMENT OF THE 

once in several weeks, to visit a friend or the shop- 
keeper ; and the habit of going out daily for the sake 
of air and exercise alone, so universal in other civil- 
ized countries, is scarcely known among them. The 
consequence is, most of them are blanched by seclu- 
sion from the fresh air, nature's great restorative ; and 
very few have much of the rosy tint of health, or are 
entirely exempt from some of the symptoms of indi- 
gestion. The frame is delicate and feeble, the system 
irritable, and its functions easily deranged by trifling 
causes; and the mind morbidly sensitive, not unfrequent- 
ly impairing the health by its immoderate emotions. But 
the evil does not stop here, for the offspring will be 
certain to inherit more or less of the mother's consti- 
tution and proneness to particular diseases, as it does 
her complexion, temper, and other peculiarities. We 
hear a great deal of hereditary gout, consumption, 
madness, &c. but there are undoubtedly many other 
diseases, though not at all suspected, that are quite as 
much so as they. 

The remittent and intermittent fevers, so prevalent in 
all our new settlements, especially in the neighbourhood 
of the great lakes and rivers, and generally known by 
the names, bilious fever, lake fever, fever and ague, 
&c. are very commonly followed by indigestion. In 
some parts of the northern and western states, during 
the summer and autumn these fevers are occasionally 
so prevalent, that nearly one half the population is 
labouring under some of their forms at the same time ; 
and those who have been once attacked, very frequent- 
ly have a return of the fever, though in a less violent 
degree, about the same season, for several years, 



DIGESTIVE ORGANS. 79 

Few who have beea often revisited by this pest of new 
countries, escape without more or less of weakness 
of the digestive organs ; which sometimes continues 
for years. They generally suffer from what I have 
considered as the first and second species. With 
some the appetite is very variable ; with others, unna- 
turally great. Some are subject to constant aciditv, 
and others to the train of symptoms termed bilious. 
When these fevers are protracted to a great length, 
they oftenoccasion enlargements of the liveror spleen, 
which are not unfrequentlv very slow in disappearing; 
but in far the greater number of cases, weakness of 
the stomach and derangement of the biliary fiincti 
are the consequence. In tie tomach would 

most probably recover its tone, and tie liver its natu- 
ral action in a reasonable time : but for number 
imprudences in eating and drinking, of which the in- 
valid is guilty. For as the fever 9nbsidefi and 
strength begins to return, the app odm vora- 

cious, though the stomach is in a great me, 
incapable of dissolving all it seems to demand ; and 
very few have reason or philosophy enough to restrain 
them from unwarranted indigencies. Three who have 
least discretion, eat heavy indigestible articles which 
the stomach is too weak to dissolve ; and those who 
give themselves great credit for a prudent choice of 
food, occasionally take so much as to overload the 
stomach, and thus produce by quantity the same evil 
which the others produce by quality. Perhaps there 
is nothing more difficult, even when the invalid is a 
physician, (and of all men should know how to control 
himself in this respect,) than to avoid one or the other 



80 DERANGEMENT OP THE 

of these errors ; or to say to that appetite little less 
than canine, "thus far shalt thou go, and no farther." 

Habitual costiveness is a cause of indigestion too 
well known to require much notice here. From what 
has been said heretofore, it will be easily understood 
why a deviation from the healthy performance of func- 
tion in one part of the alimentary canal, should soon in- 
volve the rest ; and why the stomach from the intimate 
connexion which exists among all the digestive organs, 
will not be long in responding to any irregularity of 
the bowels. 

There is but one more physical cause which I shall 
mention, and that has been set down by Europeans as 
the approbrium of Americans ; I mean the chewing of 
tobacco. Though this loathsome practice is undoubt- 
edly fast decreasing among the higher orders of soci- 
ety, and cannot be said to be peculiar to us, it is yet 
far more general here than in any other equally civil- 
ized country. This poisonous plant is injurious when 
chewed in considerable quantity, by the great waste 
of saliva it occasions, by impairing the appetite and 
giving rise to tremblings, watchfulness, and other 
symptoms indicative of its effects upon the nervous 
system. It is thought by many, that tobacco cannot 
be hurtful because thousands are constantly using it 
without any apparent evil consequences ; but this fact 
only shows what a good constitution will bear, without 
any more proving that tobacco is innoxious than it does 
when applied to rum. I have seen the most marked 
improvement in the appetite and general health after 
laying it aside. Smoking, if considerably practised, 
may be equally injurious as chewing. 



DIGESTIVE ORGANS. 81 

Moral causes. 

The most melancholy cases of derangement of the 
digestive organs are occasioned by moral causes, such 
as great grief for the loss of friends, severe disap- 
pointments in love, or the pursuits of ambition ; rever- 
ses of fortune, loss of property ; in fine, all immo- 
derate emotions of the mind from whatever cause, if 
long continued, have a powerful effect upon the diges- 
tive apparatus, and not unfrequently bring about the 
worst kinds of derangement. How it is that the mind 
exerts such an influence over these organs is not easy 
to be explained. Like many other laws of the animal 
economy, as well as of nature generally, it is involved 
in impenetrable obscurity ; but the fact itself cannot 
be doubted. From the intimate connexion between 
these organs and the mind, any disorder of the one 
will immediately show its effects upon the other. 
Thus great mental affliction disorders the stomach 
and liver, and these in turn react upon the mind, add- 
ing new horrors to the gloom that hangs over it. In 
this way they may go on disordering and being disor- 
dered, till complete insanity is induced, or fatal disease 
in the sympathising organs. 

I .have said that when indigestion is produced by 
physical causes, it often occasions great pain in the 
head, breast, or sides ; but when it is owing to moral 
causes, instead of pain, I believe the mind is more 
frequently made to suffer, though other organs, as the 
heart, lungs, and kidneys, now and then sympathise 
and attract the whole attention of the invalid. If his 
physician attempts to convince him that deranged iu 
8 



82 DERANGEMENT OF THE 

gestion is the cause of all his sufferings, and that the 
other parts of his system are perfectly sound, he will 
be apt to lose all confidence in him, and fancy that he 
has entirely mistaken his complaint. 

A long residence in warm climates often renders the 
digestive organs peculiarly irritable, of course very 
susceptible of the effects of mental causes. Hence 
we find those who have resided within or near the tro- 
pics, perhaps have made their fortune and returned 
to more northern latitudes to enjoy it with their friends, 
are very subject to melancholy, hypochondriasis, and 
low spirits ; and instead of happiness, find the remain- 
der of their existence embittered by diseases that sel- 
dom excite commiseration, and are too often considered 
as altogether imaginary. 

Treatment. 
From what has been said it must be evident that the 
diet is the first and most important thing to be attended 
to, and without it is carefully regulated, all the com- 
plicated mixtures of the apothecary will give no per- 
manent relief. It is true, many^ of them may for a 
time alleviate some of the most unpleasant symptoms, 
and thus encourage the invalid to promise himself a 
speedy cure ; but a little longer trial dispels the ^flat- 
tering delusion ; he finds that his disease is not re- 
moved, and the fond hope of health re-established 
vanishes into thin air. He flies to some other pre- 
scription — takes active cathartics, followed by bitters 
and stomachics without number — all have their short 
day of success, and are in turn discarded for some 
more approved specific. In this way one thing is 



DIGESTIVE ORGANS. 83 

tried after another till the dyspeptic becomes sickened 
with loathsome drugs, and losing all confidence in the 
doctor and his art, gives himself up as incurable. 

It is to be feared that physicians often lose their cre- 
dit by paying too little attention to the diet. They 
are apt to leave too much to the discretion of the in- 
valid, and in reply to the question, " Doctor, what 
may I eat ?" instead of enumerating the articles, direct 
u light nourishing food, always avoiding such things 
as disagree with the stomach." Now if the dyspeptic 
adhered strictly to the last part of this advice, he would 
actually stop eating altogether, for every thing disa- 
grees with him in the manner or quantity in which he 
takes it ; but he attends only to the first part, which 
relates to light nourishing food, and in fact eats and 
drinks whatsoever he most fancies. In this way I 
have known persons labouring under many of the 
worst symptoms of dyspepsia constantly taking pills at 
night and bitters through the day, and eating beef- 
steaks, or mutton-chops, for breakfast, a hearty din- 
ner of roast and boiled, and toast saturated with butter 
with their tea ; at the same time declaring with great gra- 
vity and really believing it too, that they confined 
themselves to a very light diet, because they did not 
so much as taste puddings, pies, cellery, cabbage, 
nuts, and cheese. It is absolutely necessary that the 
physician should enumerate such articles as may be 
eaten and forbid every thing else. I know that by so 
doing he will now and then lose the good opinion of 
his patient by interfering with his appetite, and the 
charge of " starving" will be brought against him ; but 
he will act consistently with the principles of a humane 



84 DERANGEMENT OF THE 

and honourable profession, and have the conscious ap- 
proval of doing his duty as an honest man. 

The first and all important lesson for the dyspeptic 
to learn is, that he has nothing to expect without a 
proper diet. He must, therefore, make up his mind 
to live entirely on such food as will agree with him, 
and not even taste any thing else. This, I acknow- 
ledge, requires no little firmness and self-denial, espe- 
cially in those who must every day sit at a table co- 
vered with what are luxuries to others, though poison- 
ous to themselves, and what they are stimulated to eat 
by their own appetite and the manner in which they 
are enjoyed by those around them. Add to this the 
frequent solicitations of, Do take a little of this ! I 
am sure it cannot hurt you — you cannot think how 
nice it is — I know you will like it, &c. Now to resist 
all this, and from those friends we love most, nothing but 
a considerable degree of philosophic firmness will an- 
swer. But the resolution must be taken and reli- 
giously adhered to, or health is out of the question. 
Most persons will do this without great uneasiness ; 
but the epicure, the real lover of good eating and 
drinking, will think it hard, and inquire perhaps if 
there is no other way. I answer, No ! all the reme- 
dies on earth will not restore tone to the stomach 
while it is daily overloaded with food, which from qua- 
lity or quantity it cannot digest. Can any reasonable 
being expect health without scrupulously avoiding the 
causes which impair it ? Or can he for a moment 
imagine himself worthy of so great a blessing, who 
has not sufficient strength of mind to pursue the only 
path that leads to it ? Does he look with horror upon 



DIGESTIVE ORGANS. 85 

the man who deliberately seeks death at the mouth of 
the pistol ? or with disgust upon him who immolates 
himself at the shrine of Bacchus ? while he is as 
surely, though more slowly, committing suicide by in- 
dulging in eating ? He must go back to the simple 
dictates of nature, so long stifled and neglected, adopt 
the plain fare which she requires, and in due time he 
will be rewarded with the enjoyment of her greatest 

g^- 
There are thousands who are actively engaged in 
business and who have the appearance of good health, 
and yet are constantly incommoded, more or less, by 
their food. The reason is, it is too hearty for them, 
and they would no longer suffer in this way if they 
would adopt a lighter diet. For instance, if they al- 
ways eat meat for breakfast, let them take plain bread 
and butter only, and instead of a great deal of meat 
for dinner, take half their usual allowance, making 
up the deficiency with bread. Still if there is uneasi- 
ness, lay aside meat altogether, and live on milk, soft 
boiled eggs, bread, and rice. I have known a gentle- 
man who was incessantly tormented by his food, get 
rid of all his unpleasant feelings and grow fleshy on 
the four articles last mentioned. 

As has been explained, the fault is not always in 
the solvent powers of the stomach. It is often the 
case that when it performs its office tolerably well, the 
liver does not furnish a sufficient quantity of healthy 
bile, of course the food is not entirely changed, the 
bowels are not excited to act as they should, and the 
tardy movement and accumulation of unaltered mat- 
ters in them, give rise to much distress. In such 
8* 



86 DERANGEMENT OP THE 

cases perfect relief is obtained by a diet that requires 
but a small quantity of bile to convert it into healthy 
chyle. Now animal food requires more than any 
other, and fat more than lean ; but milk, soft boiled 
eggs, bread, and various farinaceous articles, as oat- 
meal, arrow-root, &c. require comparatively but little. 
I have repeatedly known the happiest effects from this 
diet, and the liver, no longer irritated by animal food, 
after a time to recover its natural action. 

Besides the diet, another all-important part of the 
treatment is regular exercise in the open air. Every 
body is ready to admit the necessity of air and exer- 
cise, but what flimsy excuses are every day made, 
for neglecting to profit by them, while the stomach is 
allowed to become enfeebled by inactivity and confine- 
ment to the atmosphere of close rooms. But the 
habit of going out, not once or twice a week, but 
daily, and two or three times a day when the weather 
will permit, must be established, and when the weather 
is unfavourable, walking up and down a well aired 
apartment for several hours should be substituted. The 
best time for exercise is neither immediately before 
nor after eating, but between meals, and then not car- 
ried to the extent of extreme fatigue, as that is deci- 
dedly injurious. If the breakfast hour is eight, the 
proper period for exercise is about ten or eleven, and 
again one or two hours after dinner. This remark is 
only applicable to the cool seasons of the year, for 
when the weather is very warm, the invalid should not 
venture out during the heat of the day, but remain 
quietly within doors, and rise early and exercise in the 
cool of the morning, and again after the sun has 



DIGESTIVE ORGANS. 87 

declined sufficiently to lose his power, but not in the 
damp of the evening. With regard to rising early I 
remark once for all, the invalid must not indulge in 
bed, especially in warm weather, as nothing is more 
relaxing to the system ; nor sleep on feathers, but 
either upon a hair mattress or straw. Even if he 
requires a nap at eleven or twelve on the sofa, he ! 
should rise early for his walk. Diet will do much 
toward removing disease, but fresh air and exercise 
are indispensably necessary to restore strength. — 
What an astonishing change do we see wrought in 
dyspeptic invalids by a jaunt of a few days in the 
country. This is too well understood to require fur- 
ther comment. 

In many dyspeptics the skin, from sympathy with 
the stomach, is not perspirable, but harsh and dry. 
To relieve this, sponging daily with water or vinegar 
and water, and frictions, will do much, and by means 
of that same sympathy, have a salutary influence upon 
the stomach. 

The mind should be tranquil and cheerful, and all 
violent emotions as far as possible suppressed. Plea- 
sant society, and change of scene, are often necessary 
to accomplish this, though the above regimen would of 
itself suffice in a large proportion of cases. Immense 
advantage may now and then be derived from a small 
quantity of medicine judiciously employed, but of this 
1 shall speak more at large, when on the subject of 
treatment. 






DERANGEMENT OF THE 



Treatment of the First Species. 

The most prominent features of the first species are 
acidity, throwing up of a sour limpid fluid, sometimes 
nearly a pint at once, from half an hour to an hour 
afier each meal, more especially after breakfast; 
often very acrid, giving the tongue and throat a scald- 
ed appearance, or bitter and mixed with oily matters, 
but rarely containing any large quantity of the food 
just eaten, heartburn, eructations and belching of 
wind, headach and heaviness over the eyes before and 
after eating, gnawing sensation at the stomach, great 
flow of saliva into the mouth, without a loss of appe- 
tite, or remarkable derangement of the bowels. These 
symptoms I have endeavoured to explain as depend- 
ing upon the following causes. An enfeebled sto- 
mach, secreting a highly acid fluid, altogether unfit for 
the purposes of healthy digestion and fermentation of 
the food, from remaining too long in the stomach in an 
unchanged state. These symptoms are modified by 
the quality of the food. If vegetable, the fluid brought 
up is limpid and sour, accompanied by much flatu- 
lence ; if animal, it is thicker, and mixed with fat or 
oil, and often bitter. The treatment consists in adopt- 
ing such a diet as will best suit the weakened state of 
the stomach, correcting acidity, and restoring the tone 
of the organ. Before speaking of the diet, I must 
again call the attention of my readers to the great 
importance of never eating without an appetite, a 
positive and undoubted demand of the system for 
nourishment ; and this must be distinguished from that 



DIGESTIVE ORGANS. 89 

gnawing at the stomach, occasioned by acidity, which 
would induce them to eat almost every hour in the day. 
The stomach acquires force and activity by fasting, if 
not protracted too long, and should not be disturbed 
with food till it calls for it. For this reason the break- 
fast should be postponed from one to two hours after 
rising, unless something of hunger is felt in less time ? 
and even omitted altogether, if this does not actually 
take place ; and no food should be taken at any time, 
without a desire for it. The necessity of steadily and 
steadfastly adhering to this plan cannot be too much 
insisted upon. Eating and drinking must be only in 
compliance with the simple demands of nature, and 
not to coax and pamper a vitiated appetite ; nor on 
the other hand, should the invalid go too long without 
eating, for then the acid fluids of the stomach act 
upon its delicate lining, and not only occasion more 
or less uneasiness in the stomach, pain in the head, 
&c, but greatly increase its weakness by irritating- 
its nerves. Most writers on indigestion have advised 
a diet composed principally of animal food, when 
there is great acidity. Dr. Paris says, " We are 
however to look for permanent relief to a change in 
the food. All vegetables should be withdrawn, and a 
diet of animal food substituted." For what reason 
this is advised, it may be difficult to conceive, as we 
have the doctor's own words, that he does not consider 
the acidity to be produced entirely by fermentation. 
If he did, it would be easy to suppose that it is because 
animal food is less liable to ferment than vegetable* 
He says, "It has been a question often discussed, 
whether the acidity which occurs in the stomachs of 



90 DERANGEMENT OF THE 

dyspeptic invalids, arises from the fermentation of the 
food, or from a vitiated state of the gastric secretion. 
It appears to me that it may occasionally depend upon 
either of these causes." He says, " The substances 
which are found by experience more particularly 
liable to create this disorder, are all fried articles, but- 
ter and greasy viands, pastry and crude vegetables, 
in short, whatever is indigestible may act as its exci- 
ting cause. Broths of every description, but espe- 
cially those made of the meat of young animals, are a 
fruitful source of heartburn." Every body knows 
that some things are more digestible than others, and 
according to Dr. P. " whatever is indigestible may 
act as its exciting cause," of course whatever is most 
digestible, would appear to be the most proper food. 
Now the great point to be decided is, what is the most 
digestible food? In other words, what kind of food 
will be soonest and easiest converted into chyme and 
pass out of the stomach ? Is it animal food ? Argu- 
ments need not be brought forward to prove that it is 
not. No one, I believe, will assert that any kind of 
meat can be sooner digested than milk, bread, and 
some other articles. Why then is it so commonly 
recommended ? We are told that it is least apt to fer- 
ment. But if acidity does not depend principally 
upon fermentation, and if animal food is not the most 
digestible, still why is it recommended ? For no other 
reason I am convinced than that it has been long pre- 
scribed by those who have attributed acidity solely to 
fermentation. I am aware that in attempting to 
prove that an animal diet is not the best calculated to 
remove acidity, (I mean whenever I use this word, the 



DIGESTIVE ORGANS. 91 

constant presence of too much acid in the stomach, 
indicated by the symptoms I have enumerated, as fre- 
quent ejections of it after meals, &c.,) I am contend- 
ing with a long established prejudice, but I appeal to 
facts. The experiments of Tiedemann and Gmelin, 
satisfactorily prove that the quantity of acid even 
in the healthy stomach is greater in proportion to 
the indigestibility of the food. Thus in dogs, the acid- 
ity was greatest when they were fed on albumen, 
fibrin, bones, gristle, and the like, while it was less 
when they were fed on starch, gelatin, potatoes, and 
rice. But every dyspeptic knows that meat stays 
longer in his stomach, and longer satisfies his appe- 
tite than a piece of plain bread. The labourer knows 
the same. From experiments, it appears that boiled 
beef requires about twice the length of time for its 
digestion that bread does. The dyspeptic also knows 
that green tea, strong coffee, and wine, produce 
acidity ; in other words, whatever heats or irritates 
the stomach, has this effect. Now, if animal food 
remains longer in the stomach than bread, it must 
necessarily exhaust its energies more than bread, and 
that it is more stimulating, we have Dr. Paris's own 
words, " a diet of animal food cannot with safety be 
exclusively employed. It is too highly stimulant, the 
springs of life are urged on too fast, and disease neces- 
sarily follows. " Again he says of milk, " It is easily 
assimilated, and therefore affords a quick supply of 
aliment to the system, while it does not excite that 
degree of vascular action which is produced by other 
animal matters." 



92 DERANGEMENT OF THE 

Here then are two articles at least, admitted to be 
sooner digested and less heating and irritating than 
meat. Now let the dyspeptic put these articles to the 
test of experience, notwithstanding he may fancy that 
tender beef sits better on his stomach than any thing 
else. Wine also, for a short time, imparts a pleasant 
sensation. Let him taste nothing for ten days but the 
tenderest meat and bread, (for he will not willingly 
live on meat alone) and let his drink be water : for 
the next ten days let him taste nothing but bread and 
milk. During both experiments he shall observe strict 
moderation in eating, and his exercise, shall be the 
same, and he will then be able to form some idea 
which diet agrees with him best. I have seen acid 
brought up from the stomach after nearly every meal, 
while a small quantity of meat was eaten at dinner 
only, and this symptom disappear almost entirely by 
merely omitting it. In the case of a lady, who had 
long suffered from the most intolerable periodical 
headachs, which were called nervous, but which evi- 
dently depended upon acidity, perfect relief was ob- 
tained in a few days by living on bread and water. 
A little carbonate of soda was added to the w 7 ater. 
She might have taken milk, but had an unconquerable 
aversion to the taste of it. 

During a long period of unceasing torment from 
acidity, I lived, for times, almost entirely on animal 
food, and again on bread and milk my habits of exer- 
cise, being always the same, and 1 became thoroughly 
convinced that while I took the former the state of my 
stomach gradually became worse and worse, while the 
most marked improvement resulted from the use of the 



DIGESTIVE ORGANS. 98 

latter. It was in this way, from experience in my own 
person, that I was first led to suspect the correctness 
of the received opinion respecting animal food, and 
came to the conclusion, that the stomach would bear 
best that food which excited it least, and required the 
shortest period for its digestion. I then lived entirely 
on bread, milk, and rice for two or three months, when 
every symptom of acidity vanished. 

Much subsequent experience, in the cases of others, 
has confirmed the opinion that meat is injurious. It is 
not from the trial of any particular diet, for a day or 
two, that any correct inferences can be drawn, parti- 
cularly in the complaint now under consideration ; but 
it is only by steadily adhering to one course for weeks 
or months that we may be enabled to come at just 
conclusions. A few well authenticated facts must 
weigh more in the mind of every thinking man, than 
all the theories of the age ; and it is from facts alone, 
as noticed in my own person and in the cases of oth- 
ers, that I have been convinced of the bad effects of 
an animal diet, and of the efficacy of such an one as 
bread and milk ; and I request the profession to exa- 
mine this subject more fully for themselves, and 1 have 
no doubt they will arrive at the same conclusions that 
I have. 

The ease or difficulty with which food is digested 
does not, like common solution, depend principally 
upon its solidity. If so, fluids would be more easily 
digested than solids, and beef-soup and veal-broth 
would be more digestible than beef and veal roasted . 
But this is not the case. Food containing too large a 
quantity of fluid disturbs an acid stomach much more 
9 



94 DERANGEMENT OF THE 

than that of a certain degree of solidity, which per* 
haps is owing, in some measure, to its more readily 
fermenting. Thus a piece of dry bread will give no 
uneasiness, but if a large quantity of water be taken 
with it, there will be generally more or less acid brought 
up after it. Yet there are cases, particularly of the 
third species, where the stomach has become so ex- 
ceedingly irritable that nothing but the bland semi- 
fluids, as oatmeal gruel, arrow-root, &c. can be borne. 
It is then necessary to subsist on these till the morbid 
irritability is removed. 

Milk, the natural food of so large a proportion of 
young animals, cannot be properly placed among the 
fluid articles of diet, as it immediately coagulates on 
being received into the stomach. Dr. Johnson, whose 
valuable work on the stomach I have heretofore no- 
ticed, advises oatmeal gruel, (an article pre-eminently 
useful in the second and third species) without any 
distinction in all cases. That it is one of the most 
digestible articles of food, where there is no acidity, 
I am well aware ; but my own experience is not in its 
favour in this species. It appears to be too fluid when 
made thin, and too tenacious when thick. I have 
known a gentleman to confine himself for weeks to 
gruel made of the best English oatmeal, scarcely tast- 
ing any thing else, not even bread. But the effect 
was constant acidity, giving the mouth and throat the 
appearance of being parboiled, and the secretion of 
saliva was equal in quantity to that occasioned by mer- 
cury. In fact he spit incessantly through the day, and 
it ran from his mouth in such quantities at night as to 
require cloths to be placed on his pillow to receive it. 



DIGESTIVE ORGANS. 95 

The gruel was now discontinued and a light diet of a 
more solid kind substituted, and in a short time the 
acidity disappeared and he recovered his usual health 
and flesh. 

As I before remarked, a really fluid diet will aggravate 
every symptom in this species ; but one that forms with 
the saliva, a light pulpy mass, possessing a certain de- 
gree of solidity, will be found to agree best. The stomach 
requires the stimulus of such a mass in order to act in a 
healthy manner. The diet which I have found to succeed 
best in a large majority of cases, is bread and milk. The 
bread should be plain and stale and eaten dry by itself, 
and the milk taken from time to time, as the inclination 
may be. The object of eating the bread dry, is that it 
may be well mixed with saliva, and this with the milk 
which is coagulated in the stomach, forms a mass pos- 
sessing the requisite solidity. From these two articles 
alone, viz. a piece of plain bread and half a pint of 
milk for breakfast, as much of both as the appetite 
may demand for dinner, and the morning allowance, if 
there is appetite, for supper, I have seen the happiest 
results. There are many who are prejudiced against 
milk, and a few with whom it really does not agree, 
who will be obliged to adopt a different diet ; but I ad- 
vise all whe have no disrelish for it, to give it a fair 
trial before they strike it out of their bill of fare. 

It is unnecessary to say, that every one in his early 
days could eat milk, and if it really does not agree 
with him now, it shows how much his stomach is in- 
fluenced by habit. But in almost every instance, it 
may be brought back to a state not to be disturbed by 
what once suited it so well. In one case I recollect, 



96 DERANGEMENT OF THE 

where a milk diet was advised, it occasioned for two 
or three days both vomiting and purging ; but perse, 
verance conquered at last, and the stomach not only 
bore it pleasantly, but it was eaten with great relish. 

There are many who cannot eat milk occasionally, 
for instance at supper after a meat dinner, who will 
find no inconvenience from it if they confine them- 
selves to it entirely. In fact, I know of no one arti- 
cle that will be found on a fair trial to agree with so 
large a proportion of stomachs as milk. Those wha 
are not accustomed to eat it may commence with a 
very small quantity at first and gradually increase it. 

When the stomach will bear it, a soft boiled egg may 
be added to the allowance for breakfast, and boiled 
rice for dinner, making in all a diet of bread, milk, 
eggs, and rice. These articles taken together, form 
a bland unirritating mass of sufficient solidity for fhe 
stomach to act upon, and are easily changed into 
healthy chyle. I have seen the rose long faded from 
the cheek restored, and the thin emaciated form ac- 
quire its natural embonpoint, by changing the ordinary 
diet containing animal food for this. 

Another advantage of the milk diet is, that it re* 
moves thirst, often a very troublesome symptom, as it 
induces the invalid to take too much drink. For those 
who cannot eat milk I have found the following diet to 
answer best. The breakfast should consist of plain 
bread, (the description called pilot bread is preferable 
to the ordinary kinds) and a soft boiled egg, without 
any drink if it can possibly be dispensed with — at most 
only a small draft of water. The bread should be slowly 
chewed till it becomes a soft pulp, and the water, if 



DIGESTIVE ORGANS. 97 

necessary, should be taken a little time after eating, 
but never with the food. Those who are fond of tea 
and coffee may think it very hard, at first, to be de- 
prived of them ; but they have only to lay them aside 
for a few days, and then return to them to be con- 
vinced of their injurious effects. Nothing can be 
more pernicious than these two articles, whether taken 
strong or weak in this species. If weak, like all hot 
fluids they are debilitating to the stomach ; if strong, 
they irritate its nerves, occasion a great secretion of 
thin mucus, and in a word, are most powerful agents 
in promoting acidity. The invalid need not expect 
to recover while he persists in using them. 

The dinner, in the worst cases, should be nothing 
more than the breakfast, and the supper a bit of bread 
alone. When the acidity is comparatively but slight, 
the dinner, which should be about one or two o'clock, 
may consist of a very small bit of plain boiled mutton 
(most digestible when cold), roast beef, or boiled fowl, 
(avoiding the fat,) bread, and boiled rice. These arti- 
cles should be eaten very slowly and chewed to a per- 
fect pulp, that they may be well mixed with saliva. 
Respecting the quantity, it is utterly impossible to lay 
down any fixed rules. Many eminent writers on in- 
digestion, among whom may be mentioned Drs. Philip 
and Paris, have said a great deal about carefully 
watching for the feeling of satiety in eating ; in other 
words, they advise to eat slowly and stop the moment 
the appetite ceases. 

Now all this sounds very well in theory, but 
I unhesitatingly assert, that it will not answer in 
practice. Governed by this rule, too much will 



98 DERANGEMENT OF THE 

be constantly eaten, and I appeal to every dys- 
peptic of observation for the correctness of this 
statement. The feelings from one to several hours 
after eating must, alone, be the guide to the quan- 
tity. " It is quite preposterous," says Dr. John- 
son, " to prescribe a certain quantity or quality of 
food and drink till the power of the digestive organs 
is ascertained. I care not if the dyspeptic invalid 
begins with a pound of beef-steaks and a bottle of 
port wine for dinner. If he feel as comfortable at the 
end of two, four, six, eight, or twelve hours after this 
repast as he did between breakfast and dinner of the 
preceding day, he had better continue his regimen 
and throw physic to the dogs ; but if he has any of 
the feelings I have described after eating, he must 
come down to such a quantity and quality as does not 
produce this effect." If uneasiness is felt after six 
ounces of food, four, three, or two only should be 
taken till the stomach recovers sufficient strength to 
bear more. 

When there is weight or uneasiness at the stomach, 
dull pain of the head, listlessness, drowsiness, dispo- 
sition to sleep, or aversion to exercise, and the least 
depression of spirits after eating, the invalid may be 
sure he has taken too much ; but if he is cheerful, in- 
clined to exercise, and his forehead feels cool and free 
from pain or heaviness, he has not overstepped the 
mark. Little or no drink should be taken at dinner, 
if it can be dispensed with, without decided inconve- 
nience. When it is actually required, water is the 
best. Wine or brandy may relieve the sense of ful- 
ness and weight at the stomach when first taken, but 



DIGESTIVE ORGANS. 99 

they powerfully promote acidity and are ultimately 
hurtful. Dr. Johnson considers a small quantity of 
brandy and water as the best drink, if any is required ; 
but from several m onths' experience of its effects in my 
own person and the testimony of far the greater number 
of patients, I am thoroughly convinced that it is gene- 
rally not only useless but pernicious, unless where the 
stomach has been long accustomed to its unnatural 
stimulus, and the constitution is seriously impaired — in 
such cases it might not be prudent to omit it all at 
once. Drink, if taken at all, should be after eating, 
and not with the food. Many drink with their meals 
from habit alone, and frequently there is considerable 
thirst during the repast, which ceases altogether after 
digestion has commenced. It is a good rule never to 
take more than a wine glass full at once, and that as 
seldom as possible. 

At six or seven o'clock,! instead of tea; a piece of 
plain bread should be eaten if any thing is required ; 
but nothing should be tasted for an hour or two before 
going to bed, as it will not be well digested, and is 
liable to increase the acidity. Many who dine on ani- 
mal food can take a cup of milk with their breakfast 
and supper, with advantage, instead of coffee or tea. 

The invalid perhaps may be anxious to know how 
long he is to confine himself to such a restricted diet ? 
I answer, till his stomach will bear a more liberal al- 
lowance, be it longer or shorter ; but 1 can assure 
him when he once becomes accustomed to this simple 
regimen, he will be more and more contented with it, 
and daily feel less desire for change. Nor must he 
expect every unpleasant symptom to vanish at once — 



100 DERANGEMENT OF THE 

time is necessary to accomplish this ; but he will soon 
be convinced from the improvement in his feelings, 
that perseverance alone is requisite to perform a cure. 

While on the subject of diet, I will mention an er- 
ror into which those who suffer from this species very 
commonly fall : it is, the eating freely of such fruits 
as apples, peaches, &c. which for a little time seem to 
alleviate the uneasiness produced by acidity, and act as 
an aperient. This deceives the invalid, and he ima- 
gines they are beneficial to him, when in reality if in- 
dulged in, they greatly weaken the stomach by their 
indigestible quality, and increase the tendency to aci- 
dity. The invalid may convince himself of this by 
abstaining from them for some days and using the 
means suitable to correct acidity, and then eating freely 
of them, if he pleases at evening, and he will find the 
quantity of acid on his stomach astonishingly increased 
next day, with more or less headach, and incessant 
eructations after his meals. 

When the stomach has long been weakened and the 
quantity of acid very great, a regulated diet alone will 
not be sufficient to give immediate and entire relief. 
It is then that a few simple medicines will be of im. 
mense advantage. The pernicious effects of acid 
upon the irritable stomach have been already pointed 
out, and it will be evident to every one, that in order to 
allow it an opportunity of recovering its tone, the acid 
must for a time be destroyed. This may be done by 
some article that will unite with it chemically, and form 
an innocent compound. Prepared chalk, magnesia, 
and the alkalies have this effect ; but no one of them 
will be found at the same time so pleasant and effec- 



DIGESTIVE ORGANS'* lOf 

tual as the carbonate of soda. It unites with the acid 
and neutralizes it, forming a mild soluble salt, discharg- 
ing its carbonic acid or fixed air, which is a grateful 
-.stimulant to the stomach. As often as there is gnaw- 
ing at the stomach, an immoderate flow of saliva to 
the mouth, flatulence, eructations, and other symptoms 
denoting the presence of acid, a teaspoonful of the 
carbonate of soda dissolved in a small quantity ofwa- 
^er may be taken, sufficiently often to relieve these 
symptoms, and the rush of fixed air through the nose 
will usually point out the propriety of its use. 

In obstinate cases, the medicine I have found to be 
altogether the most efficacious, as it not only corrects 
the acidity but powerfully strengthens the stomach, is 
carbonate of iron, taken once or twice a day immedi- 
ately after eating. If taken but once a day, it should 
be after breakfast, as the acid is then most frequently 
troublesome, The carbonate of iron neutralizes the 
acid, and forms a tonic compound which effectually 
destroys the irritability of the nerves of the stomach, 
and restores its strength. The medium dose is from 
one to two scruples, and as its taste is not unpleasant,, 
may be mixed with a little water. It should be taken 
for some months, in order to have a permanent good 
effect. 

Should the bowels be occasionally confined, they 
must be relieved by senna and salts, or some other 
gentle laxative ; and if inclinfid to be constantly so, a 
pill, composed of aloetic pii'l three grains and ex- 
tract of colocynth one grain, may be taken at night or 
even morning, noon, and night, if necessary to keep 
them regular ; or should there be at any time great 



102 DERANGEMENT OF THE 

disposition to doze during the day, restless nights, 
weariness in the back and limbs, and other symptoms 
usually denoting biliary derangement, cathartics must 
be taken till they disappear, as the acidity will be 
greatly increased by any disorder in the functions of 
the biliary organs or bowels. To conclude the plan 
of treatment, the necessity of regular exercise might 
be again urged upon the invalid ; but what has here- 
tofore been said on that subject may suffice. 

As the stomach recovers its natural action, the bill 
of fare may be gradually and cautiously enlarged. 
Though the dyspeptic should never forget that he has 
a weak stomach, and that nothing is more certain than 
that imprudence will bring back his old maladies. He 
must therefore make up his mind to lire for years, if 
necessary, on a very plain diet. Tea and coffee must 
be renounced, and rich soups, gravies, fat dishes, 
cheese, pickles, salads, celery, cucumbers, and similar 
things carefully avoided as poisons. The best plan is 
to eat slowly of the plainest dishes on table, never in* 
dulging in variety, and for fear of eating too much 
of the substantial kinds, as meat, to be helped to the 
quantity intended to be eaten at first ; in this way it 
can be measured with the eye, and the danger of over- 
loading the stomach diminished. 

There are some who eat meat breakfasts, dine on 
rich viands, covered with luscious gravies, and high 
seasoned dressings, followed by a dessert of puddings, 
pastry, fruits, &c, and indulge in hearty suppers, who 
at the same time are constantly tormented with acidity, 
heartburn, headach, and depression of spirits — whose 
stomachs are only enfeebled in a comparatively tri* 



DIGESTIVE ORGANS. 10$ 

fling degree, and who would not require the strict 
regimen I have advised, to re-establish their health. 
They have only to breakfast on bread and butter 
instead of meat ; dine on plain roast and boiled, with a 
moderate allowance of vegetables, avoiding rich 
dishes, every thing under the name of dessert, and 
their hearty suppers, to enjoy excellent health. — - 
But such persons will rarely take advice in season^ 
When they find the stomach slow in mastering the 
enormous load they have laid upon it, they prefer for- 
cing it to greater activity by a draught of strong 
wine or brandy, and when they have so gorged them- 
selves as to lose their appetite, they eagerly swallow 
the nauseous drugs of the apothecary, and then return 
to their former course, to speedily prepare themselves 
for another round of the doctor's prescriptions. If 
they could be persuaded to adopt a light plain diet, they 
would soon find a marked mitigation of their com- 
plaints, a degree of cheerfulness, and buoyancy of 
spirits, a relish for exercise, and all the rational plea- 
sures of life to which they are strangers ; in a word, 
a measure of health more than sufficient to compen- 
sate for all their self-denial. 



Treatment of the Second Species. 

The second species, as we have seen, is character- 
ised by a long train of symptoms termed Hlious. 
Bitter taste in the mouth on first rising, yellow coat on 
the tongue, sallowness and heavy expression of the 
countenance, occasional feverishness, pain of the 
head, frequent attacks of giddiness, inclination to doze 



104 DERANGEMENT OF THE 

or sleep, particularly after eating, great depression of 
spirits, feeling of weight, and occasional slight sick- 
ness of the stomach, bowels almost constantly con- 
fined, or relaxed with bilious evacuations. I have 
attempted to explain how the derangement of the .sto- 
mach may involve the function of the liver, and h ow 
the unhealthy bile poured out by the liver may dis or- 
der the bowels. It must be evident therefore, that 
we have not only the stomach to regulate, but the 
liver and bowels also. To accomplish this, the di'.et 
must be suited to the condition of the stomach, at the 
same time, least likely to irritate or excite the livor ; 
and such an one may be found among the different 
farinaceous articles, such as oatmeal, arrow root, and 
others of this class. 

When the invalid is so feeble as to be unable to attend 
to any business, he will do well to confine himself for 
a time to oatmeal gruel, which may be longer used 
without dislike, than any thing else of the kind. 
From half a pint to a pint, with no other seasoning 
than salt, and a very little nutmeg to impart a light fla* 
vour, or a little sugar, may be taken three times a day, 
changing it from time to time, should there be any 
disrelish, for barley water to which a bit of lemon may 
bt added, arrow root, rice water, or gruel of Indian 
meal. If there is appetite for any thing, a piece of 
plain bread or pilot bread may be added to the above 
articles Let not the dyspeptic be frightened at this 
scanty allowance ; he will not starve upon it— on the 
contrary, 1 have often seen it adopted for weeks with 
the happiest results. 



DIGESTIVE ORGANS. 105 

Those who are able to take exercise in the opes air, 
need not descend so low in the scale of living, but may 
breakfast on stale bread, or dry toast and a cup of 
black tea, dine on oatmeal gruel, to which milk may 
be added if preferred, and plain bread, at evening, a \ 
dish of black tea and a bit of bread, is all that should 
be taken. 

During those periods of feverishness, loss of appe- 
tite, headach, &c, ordinarily called a bilious attack^ 
nothing but gruel, barley water, or arrow root should 
be tasted ; and immense advantage will be derived from 
eight or ten grains of blue pill, taken on going to bed, 
and followed by a dose of senna and Epsom salts in the 
morning. Sometimes it will be well to repeat this 
medicine every other day for a week, unless the fever- 
ishness is removed. In giving this advice, it is also 
necessary to caution the invalid against the too fre- 
quent repetition of active cathartics, particularly those 
containing calomel. For though at times they give 
great relief, it should be borne in mind that they excite 
the liver, and their repetition materially weakens the 
bowels, so that at length they can only be moved by 
medicine. But as it is necessary that the bile, so 
prone to accumulate, should be regularly evacuated, 
we must endeavour to assist nature in getting rid of it 
by the most gentle means. 

It has been stated that the bile sometimes becomes 
so thick and tenacious as to be incapable of mixing 
with the food, but clings to the surface of the bowels 
like bird-lime, occasioning a great variety of unplea- 
sant sensations. Now this morbid bile must be con- 
stantly carried off till the liver, resumes a healthy 
10 



106 DERANGEMENT OF THE 

action. To accomplish this, I have found a pill con- 
taining one grain of blue pill, and two or three grains 
of aloetic pill, taken every night, to answer every pur- 
pose. This pill should produce one and only one 
evacuation the following day. If it produce more, 
the quantity of aloetic pill must be diminished, as pur- 
ging is not desired ; and if it has not the proper effect, 
one may be taken night and morning, or a soda pow- 
der containing a little epsom salts may be taken in the 
morning. No danger need be apprehended from the 
grain of blue pill, as so small a quantity may be used 
for a considerable length of time without risk. I repeat 
it again, and wish to be distinctly understood, that 
purging should never be excited, except when there 
is feverishness, and that one evacuation a day, and 
that not too fluid, is all that is generally necessary. 

I have said that active cathartics, especially those 
containing much calomel, excite the already irritable 
liver, and weaken the bowels • with this fact, every 
one must be acquainted, who knows any thing of the 
animal economy, but sometimes such cathartics are 
required to remove large accumulations, and should be 
assisted in their operation by drinking freely of thin 
gruel, and nothing but gruel and a little bread should be 
eaten for two or three days after. This will give the 
liver and bowels time to recover from the effects of the 
medicine, while a few ounces of meat or other hearty 
food taken too soon, would not only deprive the inva- 
lid of the benefit of the cathartic, but lay the foundation 
of a more speedy renewal of all the symptoms that 
required it. 



DIGESTIVE OKGANS, 107 

It may be well to remark here, that if the invalid 
values his health or strength, he will not tamper with 
medicines, or take even an active cathartic without the 
best advice, as he may injure himself more by one 
improper step, than many days of strict regimen can 
do him good. 

Sometimes the secretions of the liver are so exceed- 
ingly depraved, that it may be necessary to take small 
doses of blue pill two or three times a day for several 
weeks, living entirely on farinaceous food. This course 
when judiciously managed, will be occasionally of 
immense advantage, as there is no medicine with 
which we are acquainted, that has a happier influence 
upon the action of the liver, than the blue pill, but it 
should always be given with caution, and never in suf- 
ficient quantities to salivate ; of course should never 
be administered except under the eye of a physician. 
Instead of the blue pill, the condition of the liver 
and the general health will be now and then materially 
improved by sponging the body, particularly the trunk 
and extremities every evening for a quarter of an 
hour or more, with warm water containing half a 
drachm of nitric acid, and the same quantity of muri- 
atic acid to the pint. The proportion of the acids may 
be increased or diminished so as to occasion a slight 
itching or tingling sensation of the skin, but nothing 
more ; at the same time the bowels must be kept open, 
(that is, one free motion daily,) with a few grains of 
aloetic pill, to which a little extract of colocynth may 
be added if necessary, to increase the effect. Per- 
haps during the use of the acid wash, or blue pill, the 
invalid will have occasional turns of extreme depres- 



106 DERANGEMENT OF THE 

sion of spirits, and such entire prostration of strength, 
that the least exertion even to stretch out his arm to 
help himself to any thing, seems impossible. The 
mole-hill in truth then becomes a mountain ; but this 
is not real weakness — it is the depression occasioned 
by an accumulation of bile. The head feels hot 
and is now and then dizzy, the hands tremble, the 
heart palpitates at every emotion or sudden noise, 
there is occasional slight chilliness and alternate 
flashes of heat, entire loss of appetite, and sometimes 
from the bile regurgitating into the stomach, rending 
pain in the head, which frequently ends in bilious 
vomiting. These symptoms will be all removed by a 
dose of blue pill and senna and salts, or some other 
mild cathartic. 

It has been mentioned in the description of the 
symptoms that nothing is more common than pain 
and tenderness in the side or pit of the stomach, ina- 
bility of lying on one side, pain in the shoulder and 
numbness of the arm, which it is to be feared, have 
been sometimes mistaken for signs of inflammation, 
and have led to bleeding, blistering, and the use of 
mercury, to the decided injury of the patient. The 
fact is, pain and tenderness in these cases, are alto- 
gether more frequently produced by derangement of 
function than by inflammation, of course, do not require 
such debilitating treatment. This is the opinion at 
present, of most of the eminent pathologists, and 
should teach us to be very cautious in the use of the 
lancet and mercury. 

When by a steady adherence to the above rules the 
tongue becomes clean, the head feels cool and free 



DIGESTIVE ORGANS. 109 

from pain, the complexion clear, the bowels easily 
kept regular, and the food is taken with relish and sits 
well on the stomach, vast advantage may**b# derived 
from a cautious use of bitters and tonics, such as a 
watery infusion of gentian and columbo, or the sul- 
phate of quinine. Half a grain of the latter dissolved 
in water, taken three times a day before eating, I have 
found far preferable to any other tonic, and have seen 
the most marked advantage derived from it, without 
increasing the dose beyond a grain. But this is truly 
dangerous ground ; for without the greatest prudence 
and discrimination, tonics will be not only useless, but 
decidedly hurtful, and often dangerous. Every thing 
depends upon their being administered at the proper 
time, that is, when the system is prepared for them. 

As the health improves, the bill of fare may be ex- 
tended a little. The breakfast and supper should still 
consist of a dish of weak black tea, with milk and su- 
gar, and plain bread or dry toast, (a cup of milk, if it 
does not disagree with the invalid, is far preferable to 
the tea.) The dinner may consist of milk, a soft boil- 
ed egg, any of the farinaceous articles, as oatmeal, 
arrow-root and rice, bread, roasted apples, and now 
and then a mealy potatoe if it can be borne : no des- 
cription of animal food should be taken. 

The rules already laid down respecting quantity, 
must not be forgotten, but a strict watch kept that the 
appetite does not take the reins at the expense of the 
powers of the stomach. 

On account of the intimate connexion that exists 
between the skin and the digestive organs, its condi- 
tion should be carefully attended to ; for as those or- 
10* 



110 DERANGEMENT OF THH 

gans occasionally suffer from sympathy with the skin, 
so may they also be benefited through the same me- 
dium. When it is dry and harsh, a warm bath once 
or twice a week, with thorough cleansing by means of 
brushes and soap, will have a tendency to re-establish 
the insensible perspiration, and restore the skin to a 
healthy state. In order to invigorate the surface, 
sponging every morning with cold vinegar and water, 
particularly during the warm season, and then rub- 
bing dry with a coarse cloth, will have an excellent ef- 
fect, preventing the liability to checks of perspiration, 
and strengthening the whole system. 

I wish to impress upon my readers the great useful- 
ness of these ablutions, particularly those of them 
whose surfaces are relaxed by a residence in hot cli- 
mates, and I can assure the invalid that he will not 
only receive much permanent benefit from this remedy, 
but will soon be delighted with its cooling and refresh- 
ing effects. The languor and lassitude more or less 
felt by every one after a sultry night, immediately 
give place to sensations of cheerfulness and vigour, 
after the cold ablution. 

In adopting the foregoing rules, the invalid will do 
well to avoid every thing that has a tendency to excite 
profuse perspiration, such as exercising^n the heat of 
the day, remaining in crowded rooms, sleeping on a 
soft bed, or in a confined apartment. He must exer- 
cise in the cool of the morning and after the sun has 
lost his power in the evening, though not after he has 
set, on account of the dew. 

A proper attention to clothing will also be neces- 
sary, and the best rule under this head is to aceommo- 



DIGESTIVE ORGANS. Ill 

date the dress to the weather, without much regard to 
season, even if it has to be changed several times dur- 
ing the day. As far as possible, such a quantity should 
at all times be worn as to feel comfortable. In damp 
chilly weather, though at midsummer, the invalid 
should wrap himself up, that his weak stomach and 
bowels may not suffer. It is not uncommon for some 
because they find themselves feeble and very sensible 
to changes of temperature, to wear flannel next the 
skin, even in the warmest weather — a practice which 
undoubtedly originated in ignorance, and has been 
propagated by prejudice. There is very little doubt 
that in summer its constant irritation tends greatly to 
increase perspiration, and bring about that weak re- 
laxed state of the surface so injurious to the digestive 
organs. The propriety of flannel in cold weather, 
will hardly be questioned by any one. If the bath 
and ablutions are employed, and cotton is worn, instead 
of linen, during warm weather, flannel will hardly be 
wanted by the most sensitive. Cotton does not occa- 
sion, when damp with perspiration and exposed to a 
current of cool air, that sense of coldness so common 
to linen. 

Treatment of the Third Species. 

The distressing affections included under this head 
are attributed to a morbid sensibility, or irritability of 
the inner surface of the stomach and bowels ; together 
with a vitiated state of the bile, and probably of the 
other secretions poured into the alimentary canah 
Instead, therefore, of directing the treatment to the 
head, chest, or other parts secondarily affected, the 






112 DERANGEMENT OF THE 

seat of the disease, viz. the digestive organs should 
occupy our principal attention. 

Our first care must be to adopt such a diet as will 
be least likely to irritate or furnish acrid matters in 
the changes it may undergo, and as far as possible of 
such a bland character as shall allow the morbidly 
sensible surfaces to recover a healthy state. From 
what has been said, heretofore, of the farinaceous ar- 
tides, such as oatmeal and arrow-root, it must be evident 
that they are better calculated to answer this purpose 
than any other, and experience has established the 
fact. 

In the worst cases, nothing has been found to suc- 
ceed so well as oatmeal gruel, which should for a time 
constitute the only nourishment taken. A short trial 
will convince the invalid if he can only take half a 
pint three times a day, that his sufferings are gradually 
alleviated by it, and that he actually gains strength, 
and a perceptible degree of cheerfulness and buoy- 
ancy of spirits, notwithstanding this scanty and at first 
perhaps insipid allowance. 

I do not thus recommend oatmeal gruel as the only 
food in the worst cases, without having repeatedly wit- 
nessed its decidedly beneficial effects, and have gene- 
rally seen a considerable degree of fondness acquired 
for it. Let the invalid commence then with it in 
such quantity as his appetite may demand, changing 
it whenever he ceases to relish it for arrow-root, rice- 
water, barley-water, and other similar articles ; none 
of which, however, will be generally found to suit the 
taste so long, or bear returning to as often, as the oat- 
meal. Sometimes it may be necessary to continue 



DIGESTIVE ORGANS. 113 

this diet for months, though in the majority of eases, 
at the end of two, three, or four weeks, bread, roasted 
apples, a little milk, and an occasional dish of black 
tea may be taken, but nothing else should be tasted 
till there is undoubted evidence that the complaint is 
effectually subdued. This, however, will not be a 
painful task; for after this plan is once spiritedly en- 
tered upon, the invalid acquires resolution and fresh 
confidence at every step. The obstacles w r hich once 
appeared insurmountable will rapidly disappear, and 
the immunity from suffering will be justly considered 
an abundant compensation for all the short-lived plea- 
sures of the palate. 

It is really astonishing with what steadiness and 
ease the dyspeptic can follow such a course as has 
just been marked out, when he once becomes con- 
vinced of its effects, and has fairly turned his back 
upon the dangerous allurements of the table. Instead 
of longing after the rich dishes which he once prized 
so highly, he learns to look upon them with indiffer- 
ence, or regards them as palatable poisons, and takes 
his simple fare with a relish which all the refinements 
of modern cookery cannot impart. This is no fiction : 
hundreds — yes, thousands can attest to its reality. 

The next thing to be attended to after the diet, is the 
regular evacuation of the morbid contents of the bow T - 
els. As has been mentioned, they are generally ex- 
ceedingly slimy and tenacious, strongly adhering to 
the delicate lining of the bowels, and occasioning by 
their irritating and poisonous qualities those horrible 
sensations which no language can describe. 

It is necessary then that the bow T els should be tho* 




114 DERANGEMENT OF THE 

roughly evacuated, from time to time, till their con- 
tents become of a more natural kind. To perform 
this, tolerably active cathartics will be sometimes re- 
quisite. At the same time it must not be forgotten, 
that cathartics in the present condition of the bowels 
will occasion more or less irritation, and often extreme 
suffering, of course should never be repeated oftener 
than is actually indispensable. 

~" The invalid has always a great dread of cathartics, 
and with good reason, on account of the suffering they 
occasion, and is disposed to defer taking them as long 
as possible ; but of two evils we must choose the least, 
which is, to carry off the morbid matters, and this 
must be done by as gentle means as possible. The 
medicines to which I generally give the preference, are 
about ten grains of blue pill, with a sufficient quantity 
of denarcotized opium, or hyosciamus to allay irrita* 
tion, taken at night, and a dose of Epsom salts, senna 
and salts, or castor oil, taken in the morning. Thin 
gruel or barley-water should be plentifully drunk to 
aid the medicine, and a little denarcotized opium taken 
as soon as it has had its effect, to compose the bowels. 
In this way much distress may be saved. It may be 
advisable to repeat the cathartic every day for a time, 
every other day twice a week, or less often as the 
symptoms may indicate. The evacuations should be 
carefully examined, as their appearance will point 
out the greater or less need of a repetition of the me- 
dicine. 

Sometimes the morbid matters will adhere so closely 
to the bowels that the foregoing medicines will not be 
sufficient to detach them. In such cases I have ao\ 



DIGESTIVE ORGANS. 115 

vised from five to fifteen grains of calomel, (as the 
strength may be) with from five to ten of Do vers' 
powder, to be taken at night, and the salts or oil in 
the morning, with the happiest effects ; but as before 
stated, calomel should not be resorted to when gentler 
means will succeed; and generally in the worst cases, 
after the bowels have been cleared by it a few times, 
the blue pill will answer every purpose. 

The plan just laid down would probably succeed in 
almost every instance, if steadily pursued for a suffi- 
cient length of time ; but in some individuals the mor- 
bid sensibility of the stomach and bowels is of such 
long standing, as to require much time and patience 
to remove it. In such cases, Dr. Johnson of London, 
first recommended a trial to be made of lunar caustic 
in pills, and several eminent physicians have since 
given their testimony in favour of its great efficacy. 
The manner of giving it will be best understood by a 
history of the following case. 

A young lady of this city had suffered for several 
years from a great variety of distressing affections, 
depending upon derangement of the digestive organs ; 
such as constant pain and uneasiness in the sto- 
mach after eating almost any kind of food, inces- 
sant severe headachs and depression of spirits, pain in 
the side, painful sense of weariness in the back and 
limbs, so much so as to render the least exercise ex- 
tremely fatiguing, violent palpitation of the heart, and 
great breathlessness from the least exertion, such as 
going too quickly across the room, or ascending a few 
steps . She had no quiet sleep at night, but was constantly 
disturbed by the most frightful dreams, frcsn which she 



116 DERANGEMENT OF THE 

often awoke bathed in perspiration, and dreading to 
fall asleep again, lest the same horrid spectacles might 
again present themselves. 

Her complexion was extremely sallow and dingy, 
and her tongue, when suffering most, was not only 
clean, but of a bright red colour. The smallest quan- 
tity of any cathartic, as a teaspoonful of salts, opera- 
ted violently, occasioning very great distress. All 
stimulants, as wine, and every tonic medicine, imme- 
diately excited pain, and greatly aggravated every 
symptom. She said she had not been able to bear 
tonics for the last five years. In February last, she 
could not sit up more than one hour at once without 
great fatigue, had not the least appetite, was easily 
agitated, her hands trembled, and her spirits were 
much depressed. After having taken freely of cathar- 
tics in the manner just pointed out, I commenced 
giving her a pill containing half a grain of lunar 
caustic, a quarter of a grain of denarcotized opium 
with a small quantity of ipecacuana, extract of colo- 
cynth and aloes, three times a day. If the pills did 
not keep the bowels free, a little salts was occasion- 
ally taken. Her only food was oatmeal gruel, of 
which she scarcely took half a pint a day. The pro- 
portion of caustic in the pills was increased till she 
took four grains daily. This course was pursued 
nearly eight weeks, when the caustic was discon- 
tinued, as the most decided improvement had taken 
place in her health. Instead of a teaspoonful of salts, 
she could now take half an ounce without any uneasi- 
ness. Her appetite began to improve, and she no 
longer felt her f>od, after eating ; she slept quietly 



DIGESTIVE ORGANS. 117 

at night, awoke refreshed and cheerful, and was free 
from her numerous painful sensations. First of April 
she took half a grain of sulphate of quinine in solution, 
three times a day, and a pill composed of one grain 
of blue pill, and two of aloetic pill every night, to keep 
the bowels regular. Her appetite was excellent, and 
her food was bread gruel, black tea, and occasionally a 
soft boiled egg. By the 10th June, she could walk two 
miles, and ascend from the cellar to the garret without 
much fatigue, was in excellent spirits, and perfectly 
free from all her former complaints, except occasion- 
ally a little headach when the bowels were not suffi- 
ciently free. She still continued to take about a grain 
of quinine three times a day, and the pills ; she ate 
bread, milk, oatmeal gruel, a little butter, soft boiled 
eggs, some tender vegetables, and other similar 
articles. She now (August) says she is in better 
health than she has been for twelve years, takes no 
medicine except an occasional pill, is gaining her 
flesh, and has a good appetite : she is advised to make 
no alteration in her diet, with which she is perfectly 
satisfied. 

When no uneasiness is felt in the digestive organs, 
but the force of the disease is spent upon the brain, 
heart, lungs, or other parts, the best effects may be 
expected from the simple diet just pointed out, together 
with the occasional use of such cathartics as are calcu- 
lated to evacuate biliary accumulations. I have seen the 
most melancholy state of mind, termed by many hypo- 
chondriasis, and differing but little from insanity, 
together with a distressing local affection, depending 
upon the condition of the digestive organs, though 
11 



118 DERANGEMENT OP THE 

nothing wrong was felt in them, yield in a few weeks 
to this plan, and heard the invalid express much 
astonishment that such dreadful mental depression, 
and a local disease considered as unquestionably fatal, 
could have been removed by such simple treatment. 

The invalid may without any risk adopt the forego- 
ing plan so far as regards diet, but let him not tamper 
with medicines. How incompetent must he be to 
judge of the propriety of taking even an active cathar- 
tic, when the greatest medical skill and prudence are 
required. 

As soon as the mind becomes cheerful, great advan- 
tage may be derived from exercise in the open air, 
particularly travelling, sponging with vinegar and 
water, and other means suitable to invigorate the 
system. 

On the moral treatment, it will be unnecessary to 
dwell long. Suffice it to say, nothing can be more 
inhuman than to add in any way to the purturbed state 
of the invalid's mind or temper, either by lightly 
treating his complaints, or attempting to convince him 
that they are imaginary or magnified by him. Every 
effort should be made to soothe and alleviate his suf- 
ferings, for he stands in need of all the kind offices of 
friendship and the support and consolations of philoso- 
phy and religion, to render his condition bearable. 
He should not be urged to go out, or see company 
except when inclined ; but so soon as the horrid load 
leaves his spirits, he should be encouraged to take 
exercise and amusement in the open air, his attention 
should if possible, be beguiled from the mental causes 
of his disease, whatever they may be, and nothing 



DIGESTIVE ORGANS. 110 

perhaps will more effectually do this than travel- 
ling. In a word, let his friends recollect that nothing 
is more unnatural than for a person to imagine himself 
ill, or in immediate danger of death, when in the per- 
fect enjoyment of health ; and though the invalid's 
complaints are not perceptible to them, let them not 
uncharitably doubt his statements because they are 
not confirmed by their own senses, but treat him with 
all the gentleness and compassion they would, if 
labouring under a fit of the gout or a broken limb, 
How keenly do we feel any want of compassion in 
our friends, when suffering from disease, and how 
materially may any mental anguish be aggravated by 
the ridicule of those we have loved best. Finally, 
let the connexions of the hypochondriac and dyspeptic 
invalid, if they would not add to the crime of inhu- 
manity the soul-harrowing reflection of having driven 
him to the awful act of self-destruction, beware how 
they treat with lightness or derision a disease whose 
horrors never can be fully known, but to those who 
have felt them. 

Conclusion. 

Thus far the diet and regimen have been pointed out, 
which may be generally adopted by the dyspeptic with 
most advantage, till the digestive process is again per- 
formed in a natural and healthy manner. It may be 
asked, how long must he adhere to a regulated diet? 
The answer is, so long as he has a weak stomach ; 
and this must depend upon a great variety of circum- 
stances. Perhaps a year or two, perhaps the rest of 



120 DERANGEMENT OF THE 

his life, as the stomach has been long in becoming 
enfeebled in many cases, so considerable time may be 
necessary to restore its pristine vigour. 

By a regulated diet however, I would not be under- 
stood to mean precisely the articles enumerated in the 
treatment of the several species, but composed of such 
articles as the invalid shall find by careful observation 
and experience to agree with him best ; and these 
will invariably be found to be the lightest and simplest 
kinds of food, eaten in moderation. For instance, 
animal food should be dispensed with in a great mea- 
sure, particularly in summer, or taken in very small 
quantities. Tea, coffee, wine, and every kind of 
spiritous potation must be relinquished as common 
drinks, by those who have suffered from the first spe- 
cies, and black tea alone may be excepted to those who 
have suffered from the second and third, while the 
farinaceous articles, including the different bread stuffs, 
most kinds of vegetables, and fruits of easy digestion, 
milk, butter and eggs, should comprise the bill of fare. 

Will any think this a hard course, thus to sacrifice 
the appetite to the health ? I answer, pleasure and 
pain, a life of comfort, and a wretched existence, in a 
word, all that is comprised in the terms health and dis- 
ease, are placed before them. Let them choose for 
themselves, and le. o one think himself worthy to 
enjoy the greatest blessing that falls to the lot of man, 
if he has not firmness and self-denial enough to follow 
the only course by which it can be obtained. If he 
prefers a short life of alternate sensual indulgence, 
and mental and corporeal torture to length of days, 
temperance and contentment, let him give full scope 



DIGESTIVE ORGANS. 121 

to his appetite, and add to the measure of his guilt 
and folly, the crime of self-destruction. 

Perhaps it will be said, why is animal food so objec- 
tionable in this country, when it is allowed by most of 
the English writers on dyspepsia ? I answer, much is 
owing to our climate. The great mass of English 
drink malt liquor the year round. Few I believe will 
assert that we can do the same with equal impunity ; 
our summers are far too warm for a beverage of this 
sort. 

But it is not the hard labourer, or man engaged in fa- 
tiguing bodily employment that I advise to abstain from 
meat ; they seldom suffer from indigestion. It is the 
student or professional man, the shop keeper, the mer- 
chant, whose occupations are principally mental, and 
the female who passes a large portion of her life within 
doors, who are better without it than with it. If they 
taste it at all, it should be during the cold season of 
the year, and then very sparingly ; but in the warm 
months they should avoid it upon the same principles 
that they do strong beer, and live upon bread, light 
vegetables, ripe fruit, milk, &c. Were this plan to 
be generally adopted, we should have much fewer 
cases of sick headach, bilious attacks, with fever, 
cholera morbus, dysentery, and many other diseases 
that might be mentioned. 

In thus urging the comparatively feeble and inactive to 
abstain from animal food altogether, particularly in sum- 
mer, I am far from believing that a very small quantity 
once a day cannot be taken without decided injury. But 
the danger is, if they taste it at all they will take too 
much. It contains too much nutriment in too condensed 
11* 



122 DERANGEMENT OF THE 

a form, and the risk of overcharging the enfeebled 
system is so great, that total abstinence from it is the 
safest course. 

Should it be too great a sacrifice for the gentleman 
to give up his nutritious food, let him turn ploughman, 
and then he may eat pork and beef three times a day 
if he pleases. For in the language of that very use- 
ful publication, the Journal of Health — " the best 
means to avoid injury from eating, as well as to pre- 
serve the healthy appetite unimpaired is, as much as 
possible, to avoid those occupations and pursuits which 
diminish the strength and vigour of the system." 

Before leaving this subject, it may be well to notice 
more fully, one or two symptoms that of themselves 
are often very troublesome, and to make some cursory 
remarks upon some of the popular remedies for dys- 
pepsia. 

Habitual Costiveness. 

In persons of sedentary habits, a confined state of 
the bowels is often a source of much inconvenience, 
and sometimes the principal cause of indigestion. I 
have already pointed out the means of obviating this 
difficulty when it depends upon derangement of the 
stomach and liver, and shall in this place give some 
simple rules for its relief, when existing as a primary 
affection. Nothing is more common than for those 
who suffer from a torpid state of the bowels to take, 
from time to time, some active cathartic medicine, 
such as calomel and jalap, tincture of aloes, or the 
great variety of purgatives vended under the name of 



m 



DIGESTIVE ORGANS. 128 

bilious pills. These all act smartly upon the bowels, 
and by repetition render them insensible to the natu- 
ral stimulus of their contents, and thus actually in- 
crease what they are intended to remove. 

The first point of importance is, as far as may be 
practicable, to break in upon the habit of constantly 
sitting, when this is the cause. Professional men and 
accountants, should invariably stand at their desk, 
and females may do the same in most cases, by having 
high work-tables. This of itself will often be suffi- 
cient to restore the action of the bowels. Much may 
also be done by visiting the water-closetVt stated pe- 
riods, say immediately after breakfast, whether there 
is inclination or not, and soliciting a movement. — 
These efforts may not be successful at first, but a little 
time and perseverance will at length often accom- 
plish the desired object. 

When these means fail, some alteration in the diet 
may be requisite. Bread of unbolted flour, or what 
is better, rye bread, is often very useful. But the 
article, I believe, which will least disappoint us, 
is a thin pudding, or what is sometimes called mush, 
made of rye flour, and eaten once or twice a day with 
mclasses. In very obstinate cases, I have seen the 
most entire success from living upon it altogether, for 
a few weeks. When the molasses is unpleasant, a 
little butter, or sugar, or milk, with nutmeg to improve 
the flavour, may be used, though I consider the former 
as most efficacious. When any alteration of diet is 
rendered, by circumstances, difficult or impracticable, 
I have seen the best results from an injection of half 
a pint or a pint of cold water every day, a few minutes 



124 DERANGEMENT OF THE 

before going to the water-closet. All that is neces- 
sary is a syringe, which every one can use himself. 

One of the most common effects of costiveness and 
the effort to void hardened stools, is piles, and where 
these do not exist there is often a very troublesome 
itching of the part, or a distressing sensation as if in- 
sects were creeping about just within the extremity of 
the intestine. In all these cases, the cold water injec- 
tion gives marked relief. In one instance, where the 
creeping sensation was, at times, so troublesome as to 
render the individual almost frantic, a complete cure 
was effected by it alone. It was necessary, at first, to 
use it repeatedly in the twenty-four hours, and it al- 
ways gave instant relief. 

Cough occasionally attends dyspepsia, and Dr. 
Philip has attempted to prove that the tendency of 
every severe case is to a species of consumption, 
which he calls dyspeptic phthisis. On the contrary, 
Drs. Johnson and Paris are opposed to this opinion, 
and maintain that dyspepsia rarely terminates in con- 
sumption, except where there is a marked, predisposi- 
tion to it. The latter doctrine appears to be best sup- 
ported by facts ; for though no one can doubt that 
dyspepsia may quicken the dormant seeds of consump- 
tion and then disappear as the more fatal malady pro- 
gresses, we daily see individuals who have laboured 
under some of its forms for many years, without any 
such result, and even old persons who have been mar- 
tyrs to it, almost ever since puberty. The cough ge- 
nerally depends upon irritation in the digestive organs 
—is rarely hard or sonorous, but a sort of hack often 



DIGESTIVE ORGANS. 125 

but little noticed by the invalid himself, and vanishes 
as soon as its cause is removed, or in other words, 
when the digestive process becomes natural. When it 
occurs in the third species it occasions much alarm, 
as it is considered to be indicative of a speedy decline. 
But these fears should be quieted as much as possible, 
by pointing out the cause, and considerable relief may 
be given by anodynes. A lozenge, made of loaf su- 
gar and gum arabic, and containing from one-twelfth 
to one-sixth of a grain of morphia may be allowed to 
dissolve slowly in the mouth and swallowed three or 
four times in the twenty-four hours with much benefit. 
But the best remedies for the cough are those which 
restore health to the digestive organs, and improve the 
system generally. 

White Mustard Seed. — Few remedies have ever 
been in greater demand, for a short time, than the 
white mustard seed ; but like most other specifics, its 
day of prosperity has quickly gone by, and from the 
lofty eminence to which public opinion had raised it 
it is fast sinking into obscurity. That it is a remedy 
of considerable efficacy in certain cases, is attested by 
well authenticated facts, of course it should not be 
abandoned altogether, because it is not beneficial in 
every instance. 

It has appeared to me to be useful only when the 
dyspepsia was depending, in a great measure, upon a 
torpid state of the bowels, and when its effects were 
to relieve this difficulty. When it does not act as 
an aperient, it is the cause of much disturbance by 
occasioning distressing flatulence, burning sensations 



126 DERANGEMENT OF THE 

in the stomach and bowels, and more or less feverish- 
ness. Speaking of this article, Dr. Johnson says in a 
note to his work, " 1 have known a great number of 
dyspeptic invalids take it, some with advantage, others 
without much effect, and in a very few instances it ap- 
peared to do harm. It certainly is not calculated for 
a very irritable state of the gastric and intestinal 
nerves, since all spicy or hot aromatic substances are 
injurious in such cases. It is when the bowels are 
very torpid, the appetite bad, and the whole system 
languid and sluggish that the white mustard seed pro- 
mises to be serviceable. If it keep the bowels open 
and produce no unpleasant feeling in the stomach, ali- 
mentary canal, or nervous system, it may be taken 
with safety. If it do not produce an aperient opera- 
tion, it can do little good and may perchance do mis- 
chief.' * 

Shampooing, rubbing, kneading, fyc. — Shampooing 
is a remedy which we have borrowed from eastern 
nations, by whom it is much employed. It consists in 
violently kneading, rubbing, and working the part to 
which it is applied. In England it has been used in 
some complaints of the limbs and joints, and in dis- 
tortion of the spine from a loss of power in the mus- 
cles of the back : in the latter disease with very con- 
siderable advantage. It is principally applicable to 
muscular parts whose action is impaired, and some- 
times succeeds when most other means have failed. 
It has been stated heretofore, that the food may linger 
too long in the stomach, undergo fermentation, and 
give rise to a great variety of unpleasant sensations, 



DIGESTIVE ORGANS. 127 

flatulence, and acidity, owing to the languid and tardy 
manner in which that organ contracts upon its con- 
tents. It has also been stated, that a torpid condition 
of the bowels, which depends sometimes in a great 
measure upon inactivity of their muscular coats, may 
bccasion many of the symptoms which characterize 
dyspepsia, and indeed be the principal agent in pro- 
ducing it. In both of these cases then, provided there 
is no inflammatory action going on in any part of the 
abdomen, smart kneading and rubbing may be bene- 
ficial. 

In order to act upon the stomach, it must be more 
or less distended ; of course, the best time is soon af- 
ter eating, when by kneading from below upward, it is 
forced against the liver and diaphragm, and its mus- 
cular coat roused to more vigorous action. Much of 
the weight and uneasy feeling which the dyspeptic ex- 
periences after eating, may be often removed by this 
process. 

The bowels can be acted on at all times, and they 
will be quickened in their movements by shampooing, 
exactly in the same way they are by the pressure and 
concussion which they receive in walking or riding on 
horseback. 

But can shampooing be considered as capable of 
performing a permanent cure, even in those cases to 
which it is most applicable, without any regard to re- 
gimen 1 In my opinion it cannot. Though it may 
relieve many of the distressing feelings occasioned by 
the food's lingering too long in the stomach and duo- 
denum, and impart a temporary vigour to these organs. 
Wine, brandy, quinine, and various bitters will, for a 
time, force the stomach to increased activity, but at 



128 DERANGEMENT OF THE 

last it gets weary of the spur, and obstinately refuses 
to obey it. So shampooing may enable this organ to 
perform wonders for a time, but unless the usual task 
it has to perform is made materially lighter by adopt- 
ing a more digestible diet, little or no permanent ad- 
vantage will be derived from it. j 

Let not the professed gourmand, the idle epicure, 
nor even the book-worm, the accountant, or delicate 
female, who never exceed one twenty-fourth of their 
time in active exercise in the open air, flatter them- 
solves that shampooing will enable them to eat with 
impunity the hearty food that is proper for the labour- 
er only. It may be usefully added to a proper regi- 
men, but it is good for nothing without it. In this 
respect it stands in the same light with every other re- 
medy. To suppose it applicable to all cases of dys- 
pepsia, is as absurd as to imagine that any one medi- 
cine will cure all diseases. Mustard seed and brandy 
have both in their turn been considered as specifics. 
The first is now and then useful, the second never. 

Waters of Saratoga and Balston. — To say that 
these waters may be ranked among the most effectual 
remedies for dyspepsia, would be to repeat what the 
experience of thousands and tens of thousands have 
placed beyond a doubt. They are most beneficial in 
the second species, and may do good in some cases of 
the third, but I have never seen them advantageous in 
the first. Where the biliary organs are deranged and 
the bowels sluggish, and to those who have suffered 
from the debilitating effects of a warm climate, they 
are pre-eminently serviceable, correcting the secre- 



DIGESTIVE ORGANS. 129 

tions of the liver, keeping the bowels regular, im- 
proving the appetite, and imparting strength to the 
whole system. 

Travelling. — No prescription is so certainly effica. 
cious, in most cases of derangement of the digestive 
organs, as travelling and a regulated diet. The con- 
stant exercise, change of air and scenery, and pleasant 
occupation of the mind, all tend to quicken the action 
of the stomach, and give strength and regularity to 
every part of the animal machine. The dyspeptic 
always finds himself improved by a long journey, and 
though he may now and then be exposed to fatigue 
and inclemencies of weather, to which he is not ac- 
customed, he is surprised to find that they seldom injure 
him, and he enjoys a buoyancy of spirits and activity 
of body to which he is a stranger when at home. 

Sea voyage. — A voyage to Europe is sometimes advis- 
ed for dyspepsia ; but I believe it is a mistaken idea that 
the voyage itself is often beneficial. The invalid is 
almost certain to suffer very much during his passage, 
from want of appetite, entire loss of tone of the sto- 
mach, and a confined state of the bowels, than which 
nothing is more hurtful. Acidity is often present, and 
as the bowels will frequently remain unmoved for eight 
or ten days together, unless medicine is taken, the 
accumulated bile regurgitates into the stomach, occa- 
sioning headach, nausea, and occasional vomiting. 
So much so is this the case, that many hardly eat one 
good meal during an ordinary passage, or if they do, 
are sure to reject it again. 

12 



130 DERANGEMENT, &C. 

But it may be asked, why is it that so many dyspep- 
tics return from Europe completely restored to health ? 
In my opinion, it is the change of climate, of scene, 
mode of living, and constant exercise while abroad ; 
together with the pleasure and excitement derived 
from visiting countries replete with interest, and offer- 
ing at every step something in the peculiarities of the 
inhabitants, towns, public buildings, &c. to attract at- 
tention. 



APPENDIX. 



The words digestible and indigestible, as applied to 
the ordinary articles of food, must always be consi- 
dered as relative terms. The stomach of one person 
will readily dissolve any thing he pleases to eat, while 
that of another can only master the simplest articles. 
Or in other words, every thing is digestible to the one 
and almost every thing is indigestible to the other. 
The cause of this difference I have attempted to ex- 
plain elsewhere, and in my remarks upon the different 
kinds of food, shall consider them as more or less 
suitable for those who have weak digestion, for which 
class of persons they are principally intended, though 
those who require no dietetic rule, but who are not 
compelled to earn their bread by the sweat of their 
brow, may perhaps find them useful in preserving the 
tone of their stomach unimpaired. 

As has been heretofore hinted at, this important 
organ is astonishingly influenced by habit. Thus it will 
in some instances, without much difficulty, dispose of 
very fat bacon, to which it has long been accustomed, 
when it would be immediately thrown into confusion 
!>y the simple sustenance most proper for an infant ; 



132 APPENDIX. 

but it will generally accommodate itself in a very little 
time to the lighter aliment, while it is sometimes im- 
possible for it ever to manage the more substantial. 

The dyspeptic, when advised to abstain from certain 
kinds of food which he digests with difficulty, will 
sometimes inquire if there is no danger by so doing, of 
his losing the power of digesting them at all? Unques- 
tionably there is, till his digestion becomes healthy. 
But should this be a consideration when health can 
never be restored without abstaining from them ? As 
well might the man who is wasting his vital powers.* 
and sapping the foundation of his system by daily 
swallowing a quart of spirits — whose bloated counte- 
nance, lack-lustre eye, and feeble and dropsical extre- 
mities already bespeak the ravages of deep-seated 
disease, demand if there is no danger in laying aside 
for a time his favourite draught, of losing the capabi- 
lity of taking his accustomed quantity of it. Should 
the invalid who eats daily half a pound of beef, live 
for three months on bread and milk only, and then eat 
his half pound of beef again, it would be apt at first 
to occasion some disturbance in his system ; and the 
man who daily drinks his quart, without being actually 
drunk, were he to give it up altogether for three 
months and then return to it — would undoubtedly b< 
overpowered with the most brutal intoxication. 

But the terms digestible and indigestible must be 
restricted very much to the quantity ordinarily eaten : 
for the stomach that cannot dispose of a full meal of 
the lightest food, will commonly digest almost any one 
article if taken by itself, in sufficiently small quantity. 
Thus a person who cannot satisfy his appetite with the 



APPENDIX. 133 

.simplest fare, without more or less subsequent incon- 
venience, can perhaps take one ounce of fat bacon 
and three ounces of bread, daily, without an uncom- 
fortable sensation. Variety materially increases the 
difficulty of digestion. A person shall eat at one 
meal six different articles, any one of which he can 
take with perfect ease, and the whole shall form a mass 
that will completely set at defiance ail the energies of 
his stomach. As a general rule, a weak stomach will 
manage a verry little of almost any one of the com- 
paratively indigestible substances, with much more 
ease than it can a great quantity of the most digestible. 
In addition to this objection to great variety, the 
stomach is much more liable to be overloaded by it, 
than by a single article. Compare the quantity a man 
eats at a sumptuous banquet, where every thing that 
can please the eye or coax the appetite is spread be- 
fore him, and what he takes at the simple repast of 
plain meat, bread, and vegetables. In the first place, 
he eats soup and bread enough for an ordinary dinner : 
then fish, followed by roast or boiled meat, fowl, and 
lastly pudding, not to mention vegetables, any one of 
which would satisfy his appetite. Finally, by way of 
dessert, he devours enough of fruits, nuts, and the 
countless combinations of the pastry-cook and confec- 
tioner, to constitute a feast for an eastern prince. 
Will any one ask whether all this farago is digested ? 
Most certainly it is not. The stomach works away at 
it for a time, till at last, as if weary of its task, it 
drives the half-dissolved mass into the bowels, from 
which a large portion of it is ultimately discharged, in 
a perfectly unchanged state. 
12* 



L&4 APPENDIX. 

The explanation of all this is very simple. We 
have seen that the stomach contracts upon its contents 
as the gastric juice acts on it, and urges the dissolved 
parts into the bowels : now one kind of food requires 
double the time for its digestion that another does, of 
course when mixed together, instead of the less diges- 
tible remaining behind for a sufficient time, it will be 
carried along with the more digestible, and a conside- 
rable part of it pass into the bowels unchanged. 
This shows the propriety of those whose stomachs are 
not the strongest, confining themselves to a few arti- 
cles, and those that require nearly the same time for 
their solution in the gastric juice, that they may be 
digested and expelled from the stomach at the same 
time. By confining themselves to a few articles, I 
mean not only at each meal, but for their sustenance 
altogether. 

We have seen that of two equally digestible sub- 
stances the stomach, from long habit, will dispose of 
the one much more readily than the other, of course, 
when debilitated, it should not be perpetually teased by 
going from one thing to another, but allowed to reco- 
rer its strength by steadily adhering to nearly the same 
bill of fare. When not materially weakened, the sto- 
mach long accustomed to meat, will occasionably for 
a time, refuse to digest milk ; and that used only to 
fruits and light vegetables, is incapable, at first, of dis- 
solving meat. It has been found even that those who 
have always subsisted on fish, though possessing the 
very firmest constitutions, are liable to suffer very 
great inconvenience from the ordinary meats, on first 
commencing with them. But a vigorous stomach, like 



APPENDIX. 135 

u, strong man, may be habituated, I may say educated, 
to almost any thing, such as mastering the blubber or 
fish oil so commonly eaten by the Greenlander ; while 
a weak stomach, like a feeble man, will be very apt to 
break down in training to perform the feats of the 
stronger. From all these facts, the dyspeptic should 
learn the great importance of simplicity and but little 
variety in his diet. 

I now pass to a brief examination of some of the 
more ordinary articles of food and drink. 

Animal food contains altogether more nutriment in 
a given quantity, and is far more stimulating than any 
other kind. After a full meal of it, the action of the 
heart is materially increased, the pulse becomes fuller 
and stronger, the face is riushed, there is inclination 
to sleep, as is produced by stimulating drinks, and 
every part of the system shows marks of excitement 
bordering on fever. Indeed, Dr. Paris has termed it the 
" digestive fever." There is always more thirst than 
after eating vegetables, which is the effect of all sti- 
mulants taken into the stomach, and the liver is excited 
to pour out a larger quantity cf bile. Hence it is that 
most persons who eat freely of meat, particularly in 
the warm Seasons of the year, are so very subject to 
what are called bilious attacks. These effects are most 
apparent in those who have lived for some time en- 
tirely on milk, bread, and vegetables, and then return 
to meat, or those of a feeble constitution and nervous 
temperament. From these facts it must be evident, 
that a meat diet can seldom, if ever, be the most pro- 
per for the delicate and nervous ; and I think enough 
has been heretofore said to prove that it is pernicious 



]3G APPENDIX. 

in every species of serious derangement of the diges- 
tive organs. 

It is to be sincerely regretted that many physicians 
have been very much in the habit of advising a meat 
diet, upon the same principles that they formerly or- 
dered bark, wine, and other stimulants, to all those 
who appeared debilitated, without ascertaining whether 
the debility depended upon an exhausted state of the 
system or upon an overloaded and overexcited condi- 
tion of all its organs. They have at last opened their 
eyes to the pernicious consequences attending an in- 
judicious use of bark and wine, and it is to be hoped, 
will soon become undeceived respecting animal food. 
So blinded have some of them been, (I regret to say 
it) on this subject, that in more than one instance where 
persons possessing good digestion, were getting very 
corpulent, so much so as to be extremely uncomforta- 
ble, they have advised them not to abstain from meat 
altogether, " lest they might become dyspeptic." 

I have said that meat is pernicious in every species 
of serious derangement of the digestive organs, and 
I again entreat my professional brethren to examine 
this subject more fully for themselves, and I appeal to 
their own unprejudiced observation and experience for 
the correctness of my statements. 

A great variety of circumstances materially influ- 
ence the digestibility of the different articles of this 
class, such as the age, sex, diet and habits of the ani- 
mal, length of time it has been killed, manner of cook- 
ing, &c. The flesh of many animals is less digestible 
when young, than after they have arrived at a certain 
age. Thus lamb and veal are not as easilv digested as 



APPENDIX. 13? 

mutton and beef. The two former are more stringy and 
gelatinous than the latter, and much less readily acted 
upon by the gastric juice. Of all the meats ordinarily 
brought to the table, perhaps beef and mutton are the 
most digestible. Beef when roasted or broiled, and 
mutton when boiled — the latter most so when cold. 
The flesh of the female is commonly more tender and 
delicate than that of the entire male ; it is also consi- 
derably influenced by the manner in which the animal 
was fattened. 

All meats are rendered more digestible by keeping 
some time, as the season will permit, before they are 
cooked. Game of every sort is much improved in 
this way. The lean parts of meat are far more diges- 
tible than the fat or gelatinous. Indeed, oil and jelly, 
though highly nutritious when digested, must be rank- 
ed among the substances that invariably bid defiance 
to the powers of a weak stomach. Fat pork, ducks ; 
and geese should, therefore, be shunned by the dys* 
peptic, on account of the great quantity of oil the} 
contain, and calf's head on account of its jelly. Most 
invalids are aware of the unwholesome nature of all 
fat dishes, but are not unfrequently much in error res« 
pecting broths and jellies. They see persons reco- 
vering from fevers and a variety of acute diseases, 
taking these last with apparent good effect, and hence 
they infer that they must be nourishing to those debili- 
tated from any cause. 

But the fact is, the energy of the digestive organs 
in him who is convalescing from a fever, bears no 
proportion to the general strength of the body ; while 
m the dyspeptic, the debility of these organs bears no 



13S APPENDIX. 

proportion to that of the rest of the system. If we 
were to be governed by the principle that the food con- 
taining the most nutriment is most suitable for the 
dyspeptic, we should confine him to fat pork and tur* 
tie soup, for the labourer will tell us that nothing 
" stands by him so long, or enables him to do so much 
work as pork," and the full fed alderman is loud in 
the praise of turtle-soup. The flesh of wild animals, 
as venison, though highly nutritious, is more dense 
than that of domestic, but is rendered much more ten- 
der by keeping till incipient putrefaction takes place ; 
nor is it less wholesome as supposed by some in this 
country, after it has become what is termed high fla- 
voured, for one of the most remarkable properties of 
the gastric juice as we have seen, is that of correct- 
ing putrescenay. The h an part of the common fowl, 
.and the breast of the turkey are far more easily 
managed by a weak stomach than many kinds of meat 
and the chyle which they form is less heating and 
stimulating ; most meats are rendered more indigesti- 
ble by the process of salting, drying or smoking, 
though this does not hold good with fat pork, for in 
salting, the oil or fat is in a measure solidified, of 
course rendered more manageable by the stomach. 
Every body knows the vast difference in the digesti- 
bility of fresh and salt beef; as to sausages, dried 
heef, pickled tongue, and every thing of this sort, they 
are only fit for the most vigorous stomachs. But the 
most important point as it respects the different meats,, 
is the manner in which they are cooked, for the most 
digestible of them may be rendered indigestible by the 
mode of cooking, or the most indigestible materially 



APPENDIX. 130 

improved by the same means. Boiling : — This opera- 
tion deprives the meat of a considerable portion of its 
nutritious properties, and is not generally the mode of 
cooking best calculated for a weak stomach, for meats 
which contain much albumen, as beef, if boiled too 
long, are rendered indigestible by the solidifying of 
the albumen, like an egg overboiled, while those 
which contain much gelatin, as veal, are converted 
into a mass too much resembling jelly to be easily 
digested. Much depends however, upon the manner 
in which the process is conducted. If kept too long 
at the boiling point, any meat may be spoiled, but a 
leg of mutton done slowly as it is termed, and not 
overdone, constitutes one of the most digestible dishes 
of meat. Something depends upon the quality of the 
water. Mutton is said to be best when boiled in hard 
water, while most vegetables (which are better boiled 
than any other way,) are best done in soft water. 
Roasting : — Roast meats, as beef, veal, lamb, and tur- 
key, will be easier managed by a weak stomach when 
roasted than boiled, if neither done too little nor 
too much. Meat rare done, particularly beef, of 
which many persons are very fond, is far from being 
easily digested, an when raw, requires the most 
active gastric juice for its solution. If overdone, it 
becomes too dense to be readily acted upon, and is 
sure to distress the invalid. It is unnecessary to say 
that roasting, like boiling, should be slowly conducted. 
Broiling : — This operation undoubtedly renders meat 
more tender than any other, for the sudden application 
of the heat hardens the surface, and retains all the 
juices. It is probably of all others, the mode of cook- 



140 APPENDIX. 

ing best suited to a feeble digestion. Baking and 
Frying : — These are the most objectionable methods 
of dressing meat. By the first, so much oil is retain- 
ed as to render it oppressive, and by the second, the 
oil becomes empyreumatic, than which there is scarce- 
ly an article more offensive to a weak stomach. The 
dyspeptic should therefore carefully avoid everything 
that has visited the frying-pan, as he would poison. 
In many parts of our country, this is a favourite way 
of cooking pork, ham and eggs, and sometimes beef, 
veal and mutton ; but let not the invalid suppose thai 
what so many thousands partake of with impunity, 
must of course be innocent for him, — by this mode of 
reasoning, he would be led to join the Greenlander in 
his feast of fish oil, or partake of the Tartar's repast 
of raw horse flesh. 

Condiments. — " These," says Dr. Paris, " may be 
defined substances which are in themselves incapable 
of nourishing, but which, in concert with our food, 
promote its digestion, or correct some of its delete- 
rious properties." The most important article of this 
class, is salt, an article that appears to be conducive 
to the health of all warm blooded animals, as evin- 
ced by the instinct which prompts them in the wild 
state, to seek though at a considerable distance, the 
waters which contain it. In our own country, the hun- 
ter takes advantage of this instinct in the deer, and 
has only to wait his arrival at the salt springs, to be 
sure of his game. Salt is a stimulant to the digestive 
organs, which seems intended by nature to perform a 
highly important office, as most animals, if deprived 
of it entirely, soon become sickly. 



APPENDIX. 141 

Persons who take too little salt with their food, are 
invariably infested with worms ; and many diseases 
among the poorer classes of England and Ireland, are 
attributed to the want of it. Indeed, it is said that 
the most severe punishment formerly inflicted in Hol- 
land, was to confine criminals to bread alone, which 
contained no salt, and we are told they were at last 
devoured by worms engendered in their own bodies. 
Children who eat freely of salt, are generally exempt 
from many of the complaints attributed to worms, 
and a draught of salt and water is a popular and very 
efficacious remedy for some of the symptoms occa- 
sioned by them. Our appetite for all other condi- 
ments, is probably in a great measure, if not entirely 
factitious, and they can be dispensed with without inju- 
ry, but salt is doubtless indispensably necessary to the 
preservation of health. Vinegar is evidently whole- 
some to most persons if taken in moderation ; but 
there are those to whom it is injurious. It prevents; 
the fermentation and consequent inconvenience occa- 
sioned by many raw vegetables, and appears to render- 
oily and gelatinous articles more digestible. By the 
dyspeptic however, it should be rarely tasted, as it is 
too stimulating for his enfeebled organs. 

Pepper, cinnamon, nutmeg, cloves, ginger, mustard, 
and every thing else of this sort, are allowable in 
moderation to persons in good health ; mixed with 
many indigestible articles, they rouse the stomach to 
greater efforts in disposing of them ; but taken too 
freely, they greatly weaken its powers. As those who 
have feeble stomachs should never eat articles that 
require high seasoning to render them digestible, nei- 
13 



142 APPENDIX. 

ther should they take any considerable quantity ol' 
spices of any description. Sugar in moderation is 
harmless to almost every one. The refined article i* 
most suitable for acid stomachs, as the species com- 
monly called brown or muscovado sugar contains 
considerable free acid, which renders it liable to fer- 
ment. The same remark applies to molasses ; but 
when they do not disagree with the stomach, they are 
slightly aperient. Oil in very small quantities seems 
to render salads less liable to ferment, but should be 
eaten only by the robust. 

Fish constitutes a diet much less heating, and 
less nutritious than the flesh of warm blooded ani- 
mals. When the stomach is vigorous and healthy, it 
does not require as much time for its digestion, nor 
does it long satisfy the appetite. From the circum- 
stance of its being much less stimulating than beet 
or mutton, it requires a greater addition of condiments, 
as salt and vinegar, and though its flavour is improved 
by drawn butter, it is rendered extremely indigestible 
by it. For many invalids, it forms a very suitable 
diet, but it will seldom if ever, agree with dyspeptics. 
Of this fact, most of those who are very observing are 
aware. For them it is evidently less digestible than 
beef or mutton, and seems to fatigue and irritate the 
stomach much more. Dr. Johnson says the plainest 
white fish is far more likely to disagree with the dys- 
peptic than animal food, and some of the severest 
attacks of indigestion he ever witnessed were caused 
by fish. Some of the species of fresh water fish, as 
trout, are perhaps least objectionable ; but nothing is 
more common than for tolerably strong stomachs to be 



APPENDIX. 14t* 

deranged by a dinner of salmon. On the whole then, 
fish, though a very wholesome food for the healthy, 
cannot be considered as at all suitable for the dys- 
peptic invalid. 

Shell fisk. — It is commonly supposed that oysters 
are very light and digestible, and that " even an 
infant may eat them with safety." But Dr. Paris says 
they " enjoy a reputation they do not deserve ; when 
eaten cold, they are frequently distressing to weak 
stomachs, and require the aid of pepper as a stimu- 
lant, and since they are usually swallowed without 
mastication, the stomach has an additional labour to 
perform in order to reduce them to chyme. When 
cooked, they are still less digestible, on account of the 
change produced upon their albuminous principle." 

Turtle, lobsters, and crabs are highly nutritious, 
and quite as indigestible. None but the most healthy 
and active should indulge in them. Even with these, 
a single dinner of turtle-soup, or a supper of lobsters 
will occasionally bring on a fit of indigestion,— of 
course they are extremely pernicious for invalids. 

Eggs. — The digestibility of eggs depends in a great 
measure upon the manner in which they are cooked. 
If boiled from two to three minutes, they sit pleasantly 
on most weak stomachs, and are very easily digested. 
when boiled too long, they become converted into a 
solid mass, that nothing less than a very strong gas- 
tric juice can dissolve. When raw, they are a little 
laxative, but not as digestible as when lightly boiled. 
Custard prepared from them, is a comparatively inno- 
cent article. 

Milk. — Of this article I have had occasion hereto- 



144 APPENDIX. 

fore to express my opinion as it respects its suitableness 
to the condition of the dyspeptic. It may be readily 
separated into three constituent parts, cream, curd, 
and whey. None of which however appear to agree 
with weak stomachs generally so well as entire milk. 

It is a peculiar property of the gastric juice, as we 
have seen, to separate the more solid parts of the milk 
from the thinner by coagulation. The thinner are 
absorbed, and the solid readily digested, and the 
stomach seems to prefer performing this operation 
itself, as it will be often oppressed by curd artificially 
prepared, and whey will sometimes turn sour upon it ; 
as to curd, when manufactured into cheese, it is 
undoubtedly one of the most indigestible articles in 
common u^e, and in a great many persons passes 
through the alimentary canal, and is discharged in 
the most entire and unchanged state. Butter when 
perfectly sweet, may be allowed in moderation to the 
great majority of persons, but when rancid, is very 
unfriendly to the dyspeptic. With those who are 
subject to acidity, even the best butter in any conside- 
rable quantity, is sure to disagree, of course should 
be cautiously eaten if at all, by those who suffer from 
the first species. What is commonly called drawn 
butter, may be properly set down as rank poison. 

Farinaceous food, — Bread in this country is princi- 
pally made of the flour of wheat, rye, and Indian corn. 
That made of wheat is the lighest and most digesti- 
ble ; but if the flour is finely bolted, is apt to constipate 
the bowels of some persons. This defect however, 
can be entirely remedied by leaving the bran in the 
flour— that is, by making the bread of unbolted flour. 



APPENDIX. 145 

and is then perhaps the best for most dyspeptics. Rye 
bread is less digestible than wheat, but when it can be 
borne on the stomach, is decidedly aperient. Bread 
made of indian corn, and what is called rye and indian, 
is for the healthy a very wholesome and nutritious 
food, but will not agree with a large portion of weak 
stomachs as well as the bran bread made of wheat. 
It is sweeter, and sufficiently aperient, but forms a 
more glutinous mass which appears not to be so readily 
acted upon by the stomach. It is important that bread 
should be light, though not allowed to ferment till it 
becomes acid, and well baked. New bread should 
never be eaten by the invalid, and is far less whole- 
some for those in health, than that which has been 
baked twenty-four hours. There is also a material 
difference as it respects dyspeptics, between leavened 
and unleavened bread. The description of unleaven- 
ed bread called sea biscuit or pilot bread, v/ill gene- 
rally agree with the stomach, when the other does not. 
and is undoubtedly one of the most digestible articles 
of food, and sufficiently nutritious of itself to main- 
tain the healthy condition of the bodj^. " The impor- 
tance of bread as an article of diet," says Dr. Paris. 
" will be easily deduced from the principles upon 
which the digestion of food in the stomach has been 
already explained. In addition to its nutritious quali- 
ties, it performs a mechanical duty of some importance. 
It serves to divide the food, and to impart a suitable 
bulk and consistence to it ; it is therefore, more 
necessary to conjoin it with articles containing much 
aliment in a small space, than where the food is both 
bulky and nutritive." Rice supplies the place of 
13* 



146 APPENDIX. 

bread to the inhabitants of a large portion of Asia, antf 
is a very useful addition to the dyspeptic's bill of fare. 
It contains a large quantity of bland mucilage, which 
renders it particularly proper where there is much 
irritability of the alimentary canal. Arrow-root, sago, 
and tapioca, are also highly valuable articles in similar 
cases. 

The Potatoe, as is well known in Ireland, furnishes 
sufficient nutriment to sustain the human system, even 
when constantly subjected to fatigue. It is never in 
perfection, but when it becomes dry and mealy by 
boiling a suitable time. When at all waxy, it is 
exceedingly unwholsome. Many dyspeptics cannot 
eat potatoes, but it is often owing to their being of a 
bad quality, or not properly cooked. When perfectly 
mealy they are certainly very digestible, but even 
then will not agree with all. Peas and Beans, when 
full grown and ripe, are very indigestible, and invaria- 
bly produce flatulence. Green peas, if not too old, 
will not often offend a weak stomach if eaten in mode- 
ration. Beets and Carrots are improper for the dys- 
peptic, but he may eat sparingly of turnips well boiled, 
and the watery part separated by pressure, or of onions 
boiled in milk and water, (or in water alone if changed 
once or twice,) till they lose their strong flavour. 
Parsnips are less objectionable than beets and car- 
rots. Cabbage is only fit for healthy people, and all 
the varieties of crude vegetables, as radishes, cucum- 
bers, celery, lettuce, &c, are poisons to a feeble sto- 
mach. Asparagus when young and tender, is not of 
difficult digestion, and may be eaten by most invalids. 

Fruits. — I have had occasion to mention the perni- 



APPENDIX. 147 

cious effects of indulgence in fruits when the digestion 
is weak, particularly when there is a tendency to acid- 
ity ; but there are some kinds, of which the invalid 
may occasionally eat a small quantity with safety. 
The most proper time for eating fruits, is the morning 
and evening ; but it never should be tasted immedi- 
ately after dinner, as it is sure to interfere with diges- 
tion. Perhaps the most digestible when raw, are the 
orange, the mellow peach, and the strawberry. The 
orange, if the pulp is avoided, may be allowed to the 
weakest stomach. Apples are perfectly innocent when 
roasted, and may be eaten with advantage by those 
who suffer from the second and third species. The 
skins of all fruits are very indigestible, and those 
fruits that have been dried, as raisins, prunes, &c, 
should be generally avoided. Grapes are harmless if 
the skins are not swallowed, and gooseberries may be 
eaten under similar restrictions. Cherries and plumbs 
are comparatively unwholesome. Melons are com- 
monly hurtful. Most kinds of preserved fruits, and 
every thing in the shape of sweetmeats, must be care- 
fully shunned. Finally, the digestibility of fresh fruits 
depends very much upon their texture ; thus a mellow 
apple or pear is tolerably digestible, while those that 
are hard, are not at all so; when unripe, nothing is 
more pernicious. 

Drinks, — It is unnecessary to say, that a certain 
quantity of fluid is as requisite to the well-being of the 
body as solid nutriment ; or to attempt to prove that 
water, pure unadulterated water, is at once the most 
natural and wholesome beverage. These are points 
admitted by all. Yet the vitiated taste of civilized 



148 APPENDIX. 

man is no longer satisfied with the cool stream, but 
must be pampered and stimulated with a vast variety 
of drinks. When any aqueous fluid is taken into the 
stomach, it is almost immediately absorbed and carried 
into the circulation. If the quantity be large, the se- 
cretions of the skin and kidneys are suddenly increased. 
Thus in warm weather, a glass of water will almost 
instantaneously perceptibly increase the perspiration. 
Hot fluids of all kinds, though sometimes refreshing 
in their immediate effects, are ultimately weakening to 
the stomach, and those reduced much below the tem- 
perature of the atmosphere are equally so. When 
the system is greatly exhausted by heat and fatigue, a 
draught of cold water will sometimes rob the vital or- 
gans of what little energy remains to them, and death 
is the consequence. 

Most writers agree that the best period for supply- 
ing the system with the fluid it requires, is sometime 
before and after meals, that is, if our food be not too 
dry. " By drinking before a meal," says Dr. Paris, 
" we place the stomach in a very unfit condition for 
the duty it has to perform. By drinking during a 
meal, we shall assist digestion if the solid matter be 
of a nature to require it, and impede it if the quantity 
taken renders the mass too liquid." The dyspeptic 
should take drink in very small quantities at his meals, 
as the food most proper for him is easily rendered too 
fluid for the stomach. 

Toast water will sometimes agree with a very weak 
stomach better than plain water, and is always a 
wholesome and agreeable beverage. 

Barley ivater is an invaluable drink when there is 



APPENDIX. 149 

any irritation in the system, and is particularly useful 
in the second and third species of indigestion. 

Gruel. — The best gruel is made of oatmeal, and 
when it is taken as a demulcent drink, may be made by 
mixing together one tablespoonful of oatmeal and 
three of cold water, and then adding a pint of boiling 
water, which is to be boiled for five minutes, stirring 
it constantly to prevent its burning at the bottom of the 
vessel. When it is desirable that it should be more 
nourishing, double the quantity of oatmeal may be 
treated in the same way, and milk may be added. 

Coffee and tea are both stimulating and narcotic. 
They perceptibly excite the stomach, and act power- 
fully on the whole nervous system. Most persons of 
a nervous temperament are more or less exhilarated 
by them, and not unfrequently pass a sleepless night 
after drinking them in the evening. To such persons 
they are very injurious, particularly if they are dys- 
peptic, notwithstanding they of all others experience 
the most refreshing and pleasurable sensations after 
taking them. To those who suffer from acidity, they 
are poison, and but little less to all who are any way 
nervous. The least objectionable article of this kind 
is black tea, but it is seldom preferred by the tea- 
drinker, for the same reason the dram-drinker does 
not prefer claret to strong wine or brandy — it is com- 
paratively but little stimulating. 

Pernicious as these articles are to a large portion of 
invalids, there appears to be no good reason why the 
healthy and robust, especially if engaged in active 
pursuits, should not use them in moderation. Indeed, 



150 APPENDIX. 

we probably owe much to their effects in promoting 
temperance in the use of more objectionable stimu- 
lants. Coffee, taken immediately after dinner, un- 
doubtedly quickens the action of the stomach, and 
promotes the digestion of fat or oily substances. 

Chocolate is so very indigestible and oppressive to 
the stomach, that few dyspeptics will be inclined to 
partake of it often. It is highly injurious to most in- 
valids. 

Cider, particularly if mingled with water, is a re- 
freshing beverage, and not unwholesome for the 
healthy, but should be cautiously . taken by those who 
have weak stomachs, as it is apt to excite acidity. 

Malt liquors. — All the articles of this class, with the 
exception of small beer, are unquestionably detrimen- 
tal, even to the most healthy in our climate during the 
warm seasons of the year. They contain very indi- 
gestible materials, which are certain to disturb most 
weak stomachs, and are apt to occasion plethora and 
its consequences, biliary derangement, &c. Even in 
the climate of England, which is much cooler than our 
own, malt liquors are considered by some of the most 
eminent of the medical profession as the undoubted 
cause of a vast many complaints. 

Wines, particularly the light wines, if sufficiently 
diluted, cannot be considered as unwholesome if used 
in moderation by persons in ordinary health ; but it 
must be evident, if the principles heretofore laid down 
be correct, that they are, more or less, hurtful to the 
dyspeptic. 

As to all distilled liquors, the word poison should be 



APPENDIX. 151 

written, in large characters, upon every vessel contain- 
ing them, and well would it be for mankind if they 
were always associated in the mind with opium, arse- 
nic, and prussic acid. Perhaps I cannot better close 
this article than by translating the remarks of Leuret 
and Lassaigne upon the immediate effects which take 
place in the stomach after drinking any alcoholic li- 
quor. " If we open an animal some time after having 
made him swallow a spirituous drink, such as brandy, 
wine, beer, or cider, we find the internal membrane 
of the stomach and intestines covered with abundance 
of thick mucus, and the liquor itself become entirely 
acid. At the same time if the quantity of brandy or 
wine had been considerable, and we open the animal 
at the end of a quarter of an hour, for example, we 
yet obtain a little alcohol in a state of purity. The 
transformation of alcoholic liquors is very easy to be 
conceived, since we know that if they are suitably 
weakened and mixed with animal matter and exposed 
to a temperature of from ten to thirty degrees (Reau- 
mur's thermometer) they are decomposed and become 
acid. If the presence of brandy, wine, &c. occasions 
an abundance of juices, both acid and charged with 
mucus, to flow into the stomach, the temperature being 
above thirty or thirty-two degrees, these liquors ought, 
to be very promptly changed. It is then in the acid 
state that spirituous drinks pass into the duodenum. 
We have seen, heretofore, that when an acid was in 
contact with the inner surface of the intestines, and 
the orifice of the biliary and pancreatic ducts, its im- 
mediate effect was to produce the secretion of the li- 



152 APPENDIX. 

quids which come from these different parts, which 
necessarily takes place in the case in question ; and the 
frequence of gastro-enteritis (by this term is meant de- 
rangement of the stomach and bowels, with irritation 
or inflammation of their inner surfaces) after a fit of 
drunkenness, is the necessary effect. An equally na- 
tural and frequent consequence of repeated excesses 
in drinking, is chronic inflammation of the liver and 
engorgement of that organ, determined by the over- 
excitement, which occasions it to secrete and pour 
bile so often and in such abundance into the duode- 



num. 



THE END, 



. 2?*? 



